Serum sIL-2R, TNF-α and IFN-γ in alveolar echinococcosis

AIM: To approach the relationship between alveolar echinococcosis (AE) pathology and level of sIL-2R,TNF-αand IFN-γ in sera and the significance of cytokines in development of AE.METHODS: After 23 patients with AE were confirmed by ELISA and ultrasound, their sera were collected and the concentrations of sIL-2R,TNF-α and IFN-γ were detected by double antibody sandwich. Twelve healthy adults served as controls. According to the status of livers of AE patients by ultrasound scanning, they were divided into 4 groups: P2,P3, P4 groups and C group (control). Average of concentrations of sIL-2R, TNF-α and IFN-yin homologous group was statistically analyzed by both ANOV and Newman-Keuls, respectively.RESULTS: The mean of sIL-2R in P2 group was 97±29, P3:226±80, P4:194±23 and control group (111±30)x103 u/L(P<0.01). The mean of TNF-α in P2 group was 1.12±0.20, P3:3.67±1.96, P4: 1.30±0.25 and control group 0.40±0.19 μg/L(P<0.01). The mean of IFN-y in P2 group was 360±20, P3:486±15, P4: 259±19 and control group: 16±2 ng/L (P<0.01).Judged by ANOV and Newman-Keuls, the mean concentrations of sIL-2R, TNF-α and IFN-y had a significant difference among groups. Except for P2group, the mean sIL-2R between other groups of AE patients had a significant difference (P<0.05). The mean of TNF-α concentration in P3 group was the highest (P<0.01). The mean of IFN-y concentration in all patients was higher than that in control group (P<0.01),but there was no difference between AE groups (P>0.05).CONCLUSION:Low sIL-2R level indicates an early stage of AE or stable status, per contra, a progression stage. Higher level of TNF-α might be related to the lesion of liver. The role of single IFN-y is limited in immunological defense against AE and it can not fully block pathological progression.     

Induced termination of pregnancy and low birthweight and preterm birth: a systematic review and meta-analyses

Background  History of induced termination of pregnancy (I-TOP) is suggested as a precursor for infant being born low birthweight (LBW), preterm (PT) or small for gestational age (SGA). Infection, mechanical trauma to the cervix leading to cervical incompetence and scarred tissue following curettage are suspected mechanisms.
Objective  To systematically review the risk of an infant being born LBW/PT/SGA among women with history of I-TOP.
Search strategy  Medline, Embase, CINAHL and bibliographies of identified articles were searched for English language studies.
Selection criteria  Studies reporting birth outcomes to mothers with or without history of induced abortion were included.
Data collection and analyses  Two reviewers independently collected data and assessed the quality of the studies for biases in sample selection, exposure assessment, confounder adjustment, analytical, outcome assessments and attrition. Meta-analyses were performed using random effect model and odds ratio (OR), weighted mean difference and 95% confidence interval (CI) were calculated.
Main results  Thirty-seven studies of low–moderate risk of bias were included. A history of one I-TOP was associated with increased unadjusted odds of LBW (OR 1.35, 95% CI 1.20–1.52) and PT (OR 1.36, 95% CI 1.24–1.50), but not SGA (OR 0.87, 95% CI 0.69–1.09). A history of more than one I-TOP was associated with LBW (OR 1.72, 95% CI 1.45–2.04) and PT (OR 1.93, 95% CI 1.28–2.71). Meta-analyses of adjusted risk estimates confirmed these findings.
Conclusions  A previous I-TOP is associated with a significantly increased risk of LBW and PT but not SGA. The risk increased as the number of I-TOP increased.     

Undulating tongue in Wilson's disease

We report an unusual occurrence of involuntary movement involving the tongue in a patient with confirmed Wilson''s disease (WD). She manifested with slow, hypophonic speech and dysphagia of 4 months duration, associated with pseudobulbar affect, apathy, drooling and dystonia of upper extremities of 1 month duration. Our patient had an uncommon tongue movement which was arrhythmic. There was no feature to suggest tremor, chorea or dystonia. It might be described as athetoid as there was a writhing quality, but of lesser amplitude. Thus, the phenomenology was uncommon in clinical practice and the surface of the tongue was seen to “ripple” like a liquid surface agitated by an object or breeze. Isolated lingual dyskinesias are rare in WD. It is important to evaluate them for WD, a potentially treatable disorder.     

Influence of Physical Activity on Bone Strength in Children and Adolescents: A Systematic Review and Narrative Synthesis

A preponderance of evidence from systematic reviews supports the effectiveness of weight‐bearing exercises on bone mass accrual, especially during the growing years. However, only one systematic review (limited to randomized controlled trials) examined the role of physical activity (PA) on bone strength. Thus, our systematic review extended the scope of the previous review by including all PA intervention and observational studies, including organized sports participation studies, with child or adolescent bone strength as the main outcome. We also sought to discern the skeletal elements (eg, mass, structure, density) that accompanied significant bone strength changes. Our electronic‐database, forward, and reference searches yielded 14 intervention and 23 observational studies that met our inclusion criteria. We used the Effective Public Health Practice Project (EPHPP) tool to assess the quality of studies. Due to heterogeneity across studies, we adopted a narrative synthesis for our analysis and found that bone strength adaptations to PA were related to maturity level, sex, and study quality. Three (of five) weight‐bearing PA intervention studies with a strong rating reported significantly greater gains in bone strength for the intervention group (3% to 4%) compared with only three significant (of nine) moderate intervention studies. Changes in bone structure (eg, bone cross‐sectional area, cortical thickness, alone or in combination) rather than bone mass most often accompanied significant bone strength outcomes. Prepuberty and peripuberty may be the most opportune time for boys and girls to enhance bone strength through PA, although this finding is tempered by the few available studies in more mature groups. Despite the central role that muscle plays in bones' response to loading, few studies discerned the specific contribution of muscle function (or surrogates) to bone strength. Although not the focus of the current review, this seems an important consideration for future studies. © 2014 American Society for Bone and Mineral Research.     

Validation of Methods to Control for Immortal Time Bias in a Pharmacoepidemiologic Analysis of Renin–Angiotensin System Inhibitors in Type 2 Diabetes

Background

Pharmacoepidemiologic analysis can confirm whether drug efficacy in a randomized controlled trial (RCT) translates to effectiveness in real settings. We examined methods used to control for immortal time bias in an analysis of renin–angiotensin system (RAS) inhibitors as the reference cardioprotective drug.

Methods

We analyzed data from 3928 patients with type 2 diabetes who were recruited into the Hong Kong Diabetes Registry between 1996 and 2005 and followed up to July 30, 2005. Different Cox models were used to obtain hazard ratios (HRs) for cardiovascular disease (CVD) associated with RAS inhibitors. These HRs were then compared to the HR of 0.92 reported in a recent meta-analysis of RCTs.

Results

During a median follow-up period of 5.45 years, 7.23% (n = 284) patients developed CVD and 38.7% (n = 1519) were started on RAS inhibitors, with 39.1% of immortal time among the users. In multivariable analysis, time-dependent drug-exposure Cox models and Cox models that moved immortal time from users to nonusers both severely inflated the HR, and time-fixed models that included immortal time deflated the HR. Use of time-fixed Cox models that excluded immortal time resulted in a HR of only 0.89 (95% CI, 0.68–1.17) for CVD associated with RAS inhibitors, which is closer to the values reported in RCTs.

Conclusions

In pharmacoepidemiologic analysis, time-dependent drug exposure models and models that move immortal time from users to nonusers may introduce substantial bias in investigations of the effects of RAS inhibitors on CVD in type 2 diabetes.Key words: cardiovascular disease, immortal time bias, renin–angiotensin system inhibitors, time-dependent Cox model, cancer, type 2 diabetes     

PREVALENCE AND DISTRIBUTION OF ABNORMAL CARBOHYDRATE TOLERANCE IN THE FAMILY MEMBERS OF KNOWN DIABETICS

204 healthy family members of 91 known diabetics were screened for abnormal carbohydrate tolerance (ACT). The prevalence of asymptomatic diabetes and impaired glucose tolerance were found to be 3.44% and 8.33% respectively. There was positive correlation in the prevalence of ACT and age of the family members. Male children of diabetic parents were at higher risk of inheriting the disease. The risk increased when compounded with obesity and mumps infection. Suitable preventive strategies have been highlighted.KEY WORDS: Abnormal carbohydrate tolerance (ACT), Diabetes mellitus (DM), Impaired glucose tolerance (IGT)