Fatty acid esters of triterpenoids and steroid glycosides from Gambeya africana

Chemical studies of the CH2 Cl2 -MeOH extract of the seeds of Gambeya africana (Baker) Pierre led to the isolation of 15 compounds. Their structures were established on the basis of spectroscopic methods and chemical reactions. They comprised five new fatty acid esters of erythrodiol, [3 beta-octacosanoyloxy-12-oleanen-28-ol, 3 beta-triacontanoyloxy-12-oleanen-28-ol, 3 beta-dotriacontanoyloxy-12-oleanen-28-ol, 3 beta-tetratriacontanoyloxy-12-oleanen-28-ol and 3 beta-hexatriacontanoyloxy-12-oleanen-28-ol], one new steroidal glycoside, [3 beta-O-beta-xylopyranosylchondrillasterol] and nine known compounds, (3 beta-octadecanoyloxy-12-oleanene, 3 beta-eicosanoyloxy-12-oleanene, 3 beta-docosanoyloxy-12-oleanene, 3 beta-acetoxy-12-oleanene, erythrodiol, 28-hydroxy-beta-amyrone, chondrillasterol, chondrillasterone and 3 beta-O-beta-glucopyranosylchondrillasterol).     

Biomechanical evaluation of immediate stability with rectangular versus cylindrical interbody cages in stabilization of the lumbar spine

Background

Recent cadaver studies show stability against axial rotation with a cylindrical cage is marginally superior to a rectangular cage. The purpose of this biomechanical study in cadaver spine was to evaluate the stability of a new rectangular titanium cage design, which has teeth similar to the threads of cylindrical cages to engage the endplates.

Methods

Ten motion segments (five L2-3, five L4-5) were tested. From each cadaver spine, one motion segment was fixed with a pair of cylindrical cages (BAK, Sulzer Medica) and the other with paired rectangular cages (Rotafix, Corin Spinal). Each specimen was tested in an unconstrained state, after cage introduction and after additional posterior translaminar screw fixation. The range of motion (ROM) in flexion-extension, lateral bending, and rotation was tested in a materials testing machine, with +/- 5 Nm cyclical load over 10 sec per cycle; data from the third cycle was captured for analysis.

Results

ROM in all directions was significantly reduced (p < 0.05) with both types of cages. There was no significant difference in reduction of ROM in flexion-extension (p = 0.6) and rotation (p = 0.92) between the two cage groups, but stability in lateral bending was marginally superior with the rectangular cages (p = 0.11). Additional posterior fixation further reduced the ROM significantly (p < 0.05) in most directions in both cage groups, but did not show any difference between the cage groups.

Conclusions

There was no significant difference in immediate stability in any direction between the threaded cylindrical cage and the new design of the rectangular cage with endplate teeth.     

Bronchiectasis in indigenous children in remote Australian communities

The rates of bronchiectasis for Indigenous children from remote Australian communities are unacceptably high, with one study showing 14.7/1000 Aboriginal children. Children with bronchiectasis need to be identified early for optimisation of medical treatment. Under-reporting of cough is common. Bronchiectasis should be suspected in children with recurrent bronchitis or pneumonia, and when, despite appropriate therapy, pulmonary infiltrates or atelectasis persist 12 weeks beyond the index illness. During acute infective episodes, oral antibiotics and chest physiotherapy to clear the airways should produce prompt resolution; otherwise, hospitalisation is necessary. Management follows the cystic fibrosis model of regular review, encouragement of physical activity, optimising nutrition, maintenance of immunisation and avoidance of environmental toxicants, including passive smoke exposure. Successful management and prevention of bronchiectasis will require improvements in housing, nutrition, and education, as well as access to comprehensive healthcare services, with coordination between primary and hospital-based healthcare providers.     

Massive pulmonary embolism: the place for embolectomy

Untreated massive pulmonary embolism is associated with a high mortality. Pulmonary embolectomy has been largely superceded by thrombolytic therapy, but there are cases in which pulmonary embolectomy remains the treatment of choice. We present three case reports and discuss the merits of the various treatments available for massive pulmonary embolism. The primary treatment of massive pulmonary embolism should be thrombolytic therapy, but for patients who are at risk of haemorrhage following surgery, who are in cardiogenic shock despite medical treatment, or fail to improve following cardiac arrest, then pulmonary embolectomy remains the treatment of choice.