Allograft osteochondral transplantation in the knee in the active duty population

The purpose of this study is to analyze the role of allograft osteochondral transplantation in the knee in the active duty population, focusing on the patient's ability to remain on active duty following the procedure. A retrospective review was performed on all active duty patients undergoing allograft osteochondral transplantation surgery of the knee at our institution from 2003 to 2011. Medical records were reviewed for patient characteristics and treatment details. Eighteen patients underwent osteochondral transplantation surgery from 2003 to 2011. One of the patients is still in the acute recovery phase of their procedure (<1 year since surgery), and one patient was already in the medical evaluation board (MEB) process at the time of surgery. Of the remaining sixteen patients, nine have either entered or completed the MEB since surgery. Six of the seven patients who have stayed on active duty remain on activity-restricting profiles. The average time from surgery to MEB for these patients was 23.2 months. In the setting of the unique demands of active duty soldiers, osteochondral allograft transplantation does not appear to be conducive to retention on active duty.     

Pretransplantation overweight and obesity: does it really affect kidney transplantation outcomes?

Objective

The objective of this study was to compare kidney transplant outcomes among pretransplantation overweight and obese patients with those with normal weight.

Methods

We performed a retrospective analysis of a sample of 448 kidney transplantations performed between 1984 and 2008 in our institution. We compared of initial graft function, postoperative length of stay, surgical complications, acute and chronic rejection rates, creatinine serum levels, and patient and graft survival, between normal weight, overweight, and obesity groups.

Results

Overweight was detected on 28.3% of the patients, and obesity on 5.8%. A male predominance was noted among the normal and overweight groups, and the opposite in the obesity group: namely, male:female ratios of 2.17:1, 3.37:1, and 0.37:1, respectively. Mean age was lower in the normal weight group (41.51 years) versus 48.36 and 46.08 years in the overweight and obesity groups, respectively. Compared with the normal weight group, recipient creatinine serum levels between 1 and 6 months were higher among the obese group, but not the overweight one. Both overweight and obese groups showed significantly higher incidences of delayed graft function (26.8% and 26.9%, respectively) versus 16.9% in the normal weight group (P = .028) and longer surgery times, ie, greater than 3 hours in 22.8% and 42.3%, respectively, versus 20.7% of the normal weight patients. Surgical complication rates were higher in both non-normal weight groups (17.3% and 26.9% vs 15.9% in the normal weight group), especially lymphocele formation and wound dehiscence (P = .031 and P < .0005, respectively). However, no differences were detected concerning postoperative length of stay, graft loss, acute or chronic rejection, and graft or patient survival.

Conclusion

Pretransplantation overweight and obesity did not seem to significantly affect kidney transplantation in the medium and long terms. The early posttransplantation period can however be disturbed by an increased incidence of surgical complications and reversible degradation of some graft functional parameters.     

Donor cause of brain death in renal transplantation: a predictive factor for graft function?

Purpose

Our aim was to evaluate the influence of donor cause of brain death on the results of kidney transplantation.

Methods

This retrospective study included 896 consecutive deceased-donor renal transplantations performed between January 1, 2000, and December 31, 2009. We compared outcomes of grafts from donors after cerebrovascular accident (CVA; n = 371) versus head trauma (HT; n = 525).

Results

Univariate analysis of pretransplantation data showed statistically significant differences (P < .05): among the following variables for the HT versus CVA groups respectively: recipient age (43.63 ± 13.2 y vs 49.80 ± 12.5 y); donor age (36.06 ± 16.6 y vs 52.57 ± 13.2 y) and time on dialysis (50.67 ± 45.034 mo vs 59.39 ± 46.3 mo). Regarding transplantation results, we observed that mean serum creatinine was significantly lower among HT recipient, at 1, 3, 6, 12, and 24 months after transplantation (P < .05). Chronic allograft nephropathy (CAN) and delayed graft function were higher among the CVA group. HT group kidneys showed significantly longer mean survival times than CVA group kidneys (102.7 ± 3.9 mo vs 94.8 ± 5.6 mo; log rank: P = .04). Upon multivariate analysis donor cause of death was not identified as an independent risk factor for graft survival or occurrence of chronic allograft nephropathy.

Conclusions

Transplantation results were better among the HT group. However multivariate regression analysis indicated that donor cause of death was not an independent risk factor for graft survival or occurrence of chronic allograft nephropathy.     

甘露聚糖肽联合吗啡对癌痛治疗的临床研究

目的：观察甘露聚糖肽联合阿片类药物治疗癌痛的临床效果。方法：采取随机、对照试验方法,64例晚期恶性肿瘤伴疼痛的患者,年龄37~69岁,VAS评分≥6,随机分为两组：吗啡组32例,甘露聚糖肽＋吗啡组32例。达到疼痛缓解时（VAS评分≤3分）维持给药直至观察终点,然后比较治疗前后的疼痛缓解程度、吗啡日均消耗量、生活质量的改变。结果：与治疗前相比,两组癌痛均有不同程度的缓解,联合用药组总缓解率高于单药组（P〈0.05）;联合用药组的吗啡日均消耗量比单药组少（P〈0.05）;联合用药组患者生活质量较单药组明显提高。结论：甘露聚糖肽联合吗啡能有效地控制癌痛,减少吗啡的用量,并能提高患者生活质量。     

地黄与熟地黄对糖尿病小鼠血糖血脂的影响

目的:比较地黄与熟地黄对链脲佐菌素(STZ)致糖尿病小鼠降血糖及血脂作用。方法:雄性C57小鼠ip链脲佐菌素(STZ)60 mg·kg-1建立糖尿病模型。地黄与熟地黄分别以6,4,2 g·kg-1剂量ig给药,1次/d,连续2周,分别观察其对糖尿病小鼠血糖血脂的影响。结果:地黄6 g·kg-1能降低链脲佐菌素致糖尿病小鼠的血糖及改善血脂水平,与模型组比较,P<0.01;地黄4 g·kg-1与熟地黄6 g·kg-1降血糖作用与模型组比较,P<0.05;地黄与熟地黄降糖尿病小鼠血糖及血脂的作用与剂量呈正相关。结论:地黄比熟地黄对链脲佐菌素致糖尿病小鼠降血糖及改善血脂水平更显著。     

栝蒌根丸水提取工艺正交优选

目的:优选栝蒌根丸水提取的最佳工艺。方法:采用4因素3水平正交设计,高效液相色谱法测定小檗碱含量,以提取物中小檗碱含量为检测指标,筛选出栝蒌根丸的优化提取条件。结果:栝蒌根丸的最佳水提取工艺为加10倍量水煎煮2.0 h,提取2次。结论:栝蒌根丸水提取工艺工艺简单、易于操作、不使用有机溶剂、成本低廉。     

中医消渴病概述

消渴又有消瘅、肺消、膈消、消中的名称。糖尿病属中医消渴范畴。消渴病常见病因有禀赋不足、饮食失节、情志失调、劳欲过度等。其常见病机为阴津亏损、燥热偏胜,阴虚为本、燥热为标,病久兼有瘀血。其常见的病变部位为主要在肺、胃、肾,尤以肾为关键。常见证型有阴虚热盛证、气阴两虚证、阴阳两虚证、血瘀气滞证。     

Ultrasound-guided technique allowed early detection of intravascular injection during an infraclavicular brachial plexus block

The reported incidence of complications after peripheral nerve blocks is generally low and varies from 0% to 5%. The injuries related to brachial plexus block are perhaps more commonly reported, than after peripheral blocks of the lower extremity nerves. Recent reports suggest that expert ultrasound guidance may reduce but not completely eliminate complications as intraneural or intravascular injection. We report a case of accidental intravascular injection of local anesthetic during infraclavicular brachial plexus block, in spite of the use of ultrasound guidance technique, and negative aspiration for blood.     

A novel technique to perform direct intraganglionar injections in rats

The present work describes a simple method for direct drug administration into the dorsal root ganglion (DRG) in anesthetized rats. This technique does not involve surgery, is easy to learn and allows behavioral testing within minutes after the injection. Based on landmarks that target the L5 DRG, an orifice was created with a guide needle through which a specially designed needle was inserted for solution injection. Its introduction into the ganglia was ensured by the triggering of an ipsilateral hindpaw reflex. The precision of the technique was checked by injections of the biological dye Pontamine Sky Blue (PSB) or C14-labeled arginine. There was no leakage of the dye to the surrounding tissues after a single 4 microl or three successive 2.5 microl injections (at 30-min intervals). Moreover, identical effects were observed with prostaglandin E2 (PGE2), morphine or glibenclamide injected intraplantarly or in the DRG, thus confirming the precision of the method and suggesting that the ganglion cells and peripheral nociceptors may display similar receptor population.     

Antigen-induced inflammatory mechanical hypernociception in mice is mediated by IL-18

There is pre-clinical evidence that therapies targeting IL-18 might be beneficial in controlling arthropathies, which are accompanied by hypernociception (nociceptor sensitization). In the present study, we addressed the hypernociceptive role of IL-18 in a model of antigen-induced inflammation in mice and its mechanisms. In naïve mice, the intraplantar injection of IL-18 induced dose- and time-dependent mechanical hypernociception, which was inhibited in IFN-γ deficient (−/−) mice, and by the pre-treatment with bosentan (dual endothelin [ET] receptor antagonist), BQ123 (ET_A receptor antagonist) or indomethacin (cyclooxygenase inhibitor). IL-18 hypernociception was unaffected in TNFR1^−/− mice or by the pre-treatment with sIL-15Rα (soluble form of IL-15 receptor), BQ788 (ET_B receptor antagonist) or guanethidine (sympathetic blocker). The ovalbumin (OVA) challenge-induced mechanical hypernociception in immunized mice was inhibited by the pre-treatment with anti-IL-18 antibody or in IL-18^−/− mice. Furthermore, IL-18 induced significant IFN-γ production in the paw skin of naïve mice. The OVA challenge-induced IFN-γ and ET-1 productions were inhibited in IL-18^−/− immunized mice, as well as ET-1 production in IFN-γ^−/− immunized mice. In addition, significant PGE₂ production was detected after IL-18 or ET-1 (via ET_A receptors) injection in naïve mice. Taken together with previous data, these results suggest that IL-18 plays a significant role in antigen-induced inflammatory hypernociception via the production of IFN-γ, ET-1 and PGE₂. Thus, IL-18 and IL-18-downstream mediators demonstrated herein might constitute targets to inhibit antigen-induced inflammatory pain.