Two‐Year Results of a Randomized Placebo‐Controlled Trial of Vertebroplasty for Acute Osteoporotic Vertebral Fractures

We previously reported the results of a randomized controlled trial that found no benefit of vertebroplasty over a sham procedure for acute osteoporotic vertebral fractures up to 6 months. We report here the 12‐month and 24‐month clinical outcomes of this trial. Eligible participants (n = 78) were randomly assigned to receive either vertebroplasty (n = 38) or a sham procedure (n = 40). Randomization was stratified by treatment center, sex, and symptom duration (<6 weeks or ≥6 weeks). Participants, investigators (except the treating radiologists), and outcome assessors were blinded to group assignments. Enrolment occurred between April 2004 and October 2008 with follow‐up completed October 2010. The primary outcome was overall pain measured on a scale of 0 (no pain) to 10 (maximal imaginable pain). Secondary outcomes included pain at rest and at night, disability, quality of life, perceived recovery, and adverse events, including incident clinically apparent vertebral fractures. At 12 and 24 months, complete data were available for 67 (86%) and 57 (73%) participants, respectively. At 12 months participants in the active group improved by 2.4 ± 2.7 (mean ± SD) units in overall pain compared with 1.9 ± 2.8 units in the sham group, adjusted between‐group mean difference (MD) 0.3 (95% confidence interval [CI], –0.9 to 1.5), whereas at 24 months participants in the active group had improved by 3.0 ± 3.1 units compared with 1.9 ± 3.0 units in the sham group, MD 1.1 (95% CI, –0.3 to 2.4). No significant between‐group differences were observed for any of the secondary efficacy outcomes at 12 or 24 months. There were no between‐group differences in incident clinical vertebral fractures up to 24 months (active: n = 14, sham: n = 13), although the study had inadequate power for this outcome. These results provide further evidence that the use of this treatment in routine care is unsupported. © 2014 American Society for Bone and Mineral Research.     

Comparison of inhibitory and binding characteristics of an antibody causing acquired von Willebrand syndrome: an assay for von Willebrand factor binding by antibody

An acquired inhibitor of von Willebrand factor (vWF) activity occurring in a patient with benign gammopathy and von Willebrand syndrome (vWS) has been partially characterized. The inhibitor-induced syndrome resulted in low to undetectable plasma levels of vWF/ristocetin, vWF/botrocetin, FVIIIR:Ag, and FVIII:C with a normal to slightly prolonged bleeding time. Platelet vWF was normal. Intensive and continuous infusion of a heat-treated factor VIII concentrate (Hemofil- T, Hyland, Glendale, Calif) elevated the FVIII:C plasma levels to about 100%, with an increase in FVIIIR:Ag levels to about 340% and vWF/ristocetin levels to about 40%, much lower than expected based on the dose of Hemofil-T and its content of vWF and FVIII:C activities. The inhibitor bound to staphylococcal protein A (SpA) with high affinity, indicating an IgG antibody (Ab). An assay for the vWF-binding capacity was developed on the basis of absorption of the Ab from serially diluted plasma by SpA and removal of vWF and FVIII:C activities from normal plasma by the SpA-Ab complex. The Ab-binding site was on the vWF component of the factor VIII complex. The Ab was unable to bind isolated FVIII:C. The combined use of the new vWF- binding assay and a battery of tests for inhibition of vWF-dependent platelet aggregation with ristocetin (which detects high molecular weight vWF), with botrocetin (which detects high and low molecular weight vWF), and with platelet-aggregating factor (which detects high molecular weight vWF) provided a means of analysis of Ab effect on in vitro vWF function. Using these tests, a comparison was made of the effects of the vWS Ab with those of an Ab inhibitor occurring in homozygous von Willebrand's disease. The Ab of the vWS patient had weak inhibitory action on vWF/ristocetin without having an effect on vWF/botrocetin and platelet-aggregating factor, a high titer vWF- binding capacity, and no anamnestic response following concentrate therapy. These findings contrasted with those of the Ab occurring in inhibitor von Willebrand's disease in which vWF inhibitor and binding values were similar, with a strong anamnestic response. The findings indicate that the vWS Ab binds to an epitope on the molecular vWF in such a way that causes only limited inhibition of vWF/ristocetin function and no inhibition of vWF/botrocetin function, suggesting that these two functional domains are at separate sites.     

An Initial Experience of Continuous Peritoneal Dialysis in Children in the Armed Forces

Background

Continuous peritoneal dialysis (CPD) is a modality of renal replacement therapy in children with renal failure. A retrospective study analysis of CPD data over four years at our center was carried out.

Methods

Ten children with renal failure on CPD were included. Depending on the supply, peritoneal dialysis (PD) fluids of two different brands were used in the same patients over time. The patient months of CPD were divided into two groups based on the brand of PD fluid used. The rates of complications with the two different fluid brands were compared.

Results

The mean age of our patients was 8.8 ± 2.51 years (range 4 – 13), with a total of 141 patient months of CPD. The mean follow up period was 13.6 months (range 1- 48). The commonest underlying renal pathology was focal segmental glomerulosclerosis in 30%, followed by cresentric glomerulonephritis in 20%. Peritonitis rate was 0.48 episodes per patient year. Patients in Group I had one episode of peritonitis per 53.5 patient months and Group II had one episode per 7.25 patient months (p= 0.021, relative risk of 7.3). Patients in Group I had one episode of hypertensive encephalopathy per 107 patient months and Group II had one episode per 4.8 patient months (p= 0.001, relative risk of 21.9). On analyzing the outcome, four patients were eventually transplanted, three continued on CPD awaiting a renal transplant, two died and one recovered spontaneously.

Conclusion

CPD is an effective bridge to renal transplant in children with end stage renal disease. The risk of developing peritonitis and hypertensive encephalopathy varied with the brand of fluid used over time in the same set of patients.Key Words: Continuous peritoneal dialysis, Peritonitis     

B超引导神经内镜微创手术治疗高血压脑出血的临床应用

目的探讨神经内镜结合术中B超微创治疗高血压脑出血的手术方法及疗效。方法将32例手术指征明确但未出现脑疝的高血压脑出血患者分为两组,B超辅助下内镜治疗组16例,以神经内镜在B超辅助下清除血肿;常规开颅血肿清除组16例,行常规骨瓣开颅清除血肿,术中不使用B超。对比两组患者的血肿清除率和临床疗效。结果神经内镜下可清晰看到活动性出血点或责任血管,止血可靠。术中B超辅助下可明确血肿清除程度。B超辅助下内镜治疗组平均血肿清除率为(95.1±6.1)%,常规开颅血肿清除组为(90.2±5.0)%,神经内镜结合术中B超清除血肿组临床疗效良好率、血肿清除率均优于常规开颅血肿清除组(P相似文献   

Randomized trial of umbilical arterial catheter position: clinical outcome

In order to determine if umbilical arterial Catheter position affects the incidence of necrotizing enterocolitis, clinical outcome was analysed in 308 infants whose umbilical arterial catheter had been randomly allocated to a high ( n =162) or a low ( n =146) position. Necrotizing enterocolitis was classified as suspected or confirmed; all renal, lower limb and local catheter complications were also recorded. High umbilical arterial catheters were in place for longer than low catheters, provided more samples and were removed as an emergency less often. Lower limb blanching and cyanosis were more common with low catheters. Eleven cases of confirmed necrotizing enterocolitis occurred in the "high" group and nine in the "low" group. One case of fatal aortic thrombosis was encountered in the high group. Positioning umbilical arterial catheters in a high position allowed longer functional use and did not increase the incidence of necrotizing cnterocolitis.     

Nordic children with myelomeningocele. Parents' assessments of the handicap and physicians' classifications of the disabilities

The differences between parents' assessments of their child's handicap and professionals' assessment of disabilities were studied in 486 Nordic children with myelomeningocele aged 4–18 years. Although disability and handicap are conceptually different, agreement between the parents' assessments of the handicap and the degree of disability according to Lorber's classification was found in 51% of cases. The parents' assessments showed close agreement with overall disability according to Lagergren's method in 45% of cases. The factors most strongly associated with parental assessment of the handicap were the child's motor disability, intellectual functioning, faecal and urinary incontinence and the parents' inclination to feel inadequate with respect to the child's needs. Data from professional assessment of disabilities alone are of limited value in understanding the impact of disabilities on the daily life of a child.     

Urinary N-acetyl-beta -D-glucosaminidase and its isoenzymes A & B in workers exposed to cadmium at cadmium plating

Objective  

The present study was carried out to determine the effect of cadmium exposure on Urinary N-acetyl-beta -D-glucosaminidase and its isoenzymes A and B in workers exposed at cadmium plating.     

TGF-β2对树突状细胞表型和功能的影响

目的: 研究转化生长因子-β2 (TGF-β2)对树突状细胞(dendritic cells, DC)表型和功能的影响. 方法: 体外培养骨髓来源的DC(BMDC)及TGF-β2诱导的DC(TGFβ2-DC). 采用双色免疫荧光化学染色或流式细胞仪(FCM)分析DC的细胞表型. 分离纯化脾脏来源的同种异体T细胞和CD4+ T细胞. 用BMDC及TGFβ2-DC刺激T细胞增殖,并用混合淋巴细胞反应(MLR)测定其能力. 在CD4+ T细胞与BMDC或TGFβ2-DC共培养5 d后,用FCM检测CD4+ T细胞表型的变化. 结果: BMDC表现为CD11c, CD86, MHC class II+和CD8а-的髓系DC. TGF-β2的诱导抑制了DC表面协同刺激分子、MHC classII的表达(P<0.01),并抑制其刺激同种异体T细胞增殖的能力. 与BMDC诱导的CD4+ T细胞相比,TGFβ2-DC诱导的CD4+ T细胞CD152(细胞毒T淋巴细胞相关分子4, CTLA-4)表达上升(P<0.01). 结论: TGF-β2的诱导促使DC表面协同刺激因子表达下降,T细胞合成CTLA-4增加,T细胞的活化和增殖受到明显抑制.