磷酸三钙骨水泥骨长入的实验

目的:找出磷酸三钙骨水泥中磷酸三钙合适的比例(既能成骨又不影响骨水泥的机械性能),并观察磷酸三钙骨水泥中在动物实验中骨长入的特点。方法:①磷酸三钙比例的筛选:根据骨粒骨水泥的研究基础,将普通骨水泥(上海第二医科大学第九人民医院科技开发公司出品)中加入30%,35%,40%的直径200～300μm能成骨的磷酸三钙颗粒(法国Bio-LuCo.提供),测试其抗压强度和弹性模量,找出合适的比例。②动物实验:将25只成年新西兰大白兔随机分成术后2,4,8,12,16周组5组,每组5只。无菌下在两侧股骨远端垂直于股骨做直径6mm,长12mm的圆柱样缺损,两侧随机填入35%磷酸三钙骨水泥(实验侧)和普通骨水泥(对照侧)进行骨长入的观察。分别于术后2,4,8,12和16周取材,观察骨水泥表面的骨生长和机械强度变化。结果:①随着磷酸三钙的比例增加,磷酸三钙骨水泥的抗压强度逐渐下降,而其弹性模量则逐渐上升(P<0.05),加入35%磷酸三钙时抗压强度为(86.30±0.57)MPa,弹性模量为(2.80±0.16)GPa,比例合适。②磷酸三钙骨水泥植入兔股骨2周时表面无明显变化,4周即开始有表面粗糙,但表面骨组织附着不明显,植入8周时骨水泥表面少量骨组织附着;12周骨水泥表面骨组织附着明显;16周骨水泥表面骨组织附着明显增多。对照侧仅见一薄层纤维结缔组织。③磷酸三钙骨水泥植入兔股骨第4周时抗压强度低于植入第2周[(83.50±1.21),(85.20±0.85)MPa,P<0.05],随后上升,至植入第16周时为(87.10±1.00)MPa(P<0.05)。弹性模量在植入12周时低于植入第2周[(2.30±0.16),(2.70±0.15)GPa,P<0.05],但在16周时上升为(2.80±0.16)GPa]。结论:①磷酸三钙骨水泥中磷酸三钙的比例35%最为合适。②随着骨水泥表面的磷酸三钙颗粒被吸收和新骨长入,具备部分生物活性,机械强度符合骨缺损充填的基本要求。     

Insulin and insulin-like growth factor-1 action on human skeletal muscle: preferential effects of insulin-like growth factor-1 in type 2 diabetic subjects

The metabolic actions of insulin and insulin-like growth factor-1 (IGF-1) were compared in cultured skeletal muscle cells from nondiabetic (ND) and type 2 diabetic subjects. Insulin stimulated glucose uptake with comparable sensitivity in ND (EC(50) = 2.0 +/- 0.7 nmol/L) and diabetic (1.3 +/- 0.4) cells. IGF-1 sensitivity for uptake stimulation was similar in ND (EC(50) = 0.30 +/- 0.06 nmol/L) and type 2 cells (0.37 +/- 0.01). In ND cells, insulin and IGF-1 were equally potent for stimulation of glucose uptake and glycogen synthase (GS) activity. However, in diabetic cells, maximal insulin stimulation of both responses was only half of the increases due to IGF-1. Final absolute activities after IGF-1 stimulation were still lower in diabetic cells compared with cells from ND subjects. Hormonal stimulation of Akt phosphorylation exhibited the same behavior as metabolic responses; comparable for insulin and IGF-1 in ND muscle, while IGF-1 was significantly more effective in diabetic cells. Both insulin receptor (IR) binding and receptor protein expression were similar in ND and diabetic cells. IGF-1 binding and receptor protein expression were not significantly different in diabetic compared with ND cells. The expression of IGF-binding proteins (IGFBP) 3, 5, and 6 were similar in ND and diabetic cells; IGFBP-4 was slightly, but significantly higher, in diabetic cells. While insulin and IGF-1 are equally effective on metabolic responses in ND muscle, diabetic muscle cells are markedly more resistant to insulin than IGF-1. The greater metabolic activity of IGF-1 in type 2 diabetic muscle may provide new insights into the mechanisms of insulin resistance in skeletal muscle.     

Predictive factors associated with three years of response to HbA1c goals with exenatide QW or insulin glargine: Post-hoc analysis of the DURATION-3 study

This post-hoc analysis of the DURATION-3 study aimed to identify factors associated with sustained glycaemic response with exenatide once weekly (QW) or insulin glargine (IG) among patients with type 2 diabetes. Response was defined as achieving treatment target of HbA1c <7.0% (<53 mmol/mol) at Week 26; sustained responders maintained the treatment target for ≥80% of remaining visits, including one during the final 6 months. Of 467 patients, 287 (61.5%) completed 156 weeks of treatment. At Week 26, 175 patients (61.0%) (exenatide QW, n = 95; IG, n = 80) achieved an HbA1c response. At Week 156, 84 of 175 responders (48.0%) had sustained response, with more sustained responders with exenatide QW (22.7% vs 13.9% with IG; P < 0.03). Logistic regression identified three predictors of sustained response: (a) exenatide QW vs IG treatment (odds ratio, 2.584 [95% confidence interval, 1.288-5.187]; P = 0.0075), (b) lower HbA1c at Week 26 (0.139 [0.053-0.366]; P < 0.0001), and (c) lower fasting serum glucose at Week 26 (0.693 [0.541-0.888]; P = 0.0037). A regression model was used to estimate the likelihood of sustained response with either treatment. This analysis provides a helpful tool for predicting sustained response with exenatide QW or IG.     

Selection and outcome of the potential live liver donor

Background and aim

A thorough donor evaluation in the living donation process is mandatory to ensure a safe outcome in an otherwise healthy individual. The aim of the current study was to evaluate the reasons for not proceeding to donation and the outcome of live liver donors.

Methods

A prospective study of potential donors who underwent evaluation and proceeded to surgery from 1 April 2012 to 31 January 2015 was conducted. The process of donor selection, its outcome and peri-operative complications were recorded.

Results

A total of 460 donors were evaluated in a stepwise manner for 367 potential recipients. Of the 321 (69.7 %) donors not proceeding to donation, the reasons were donor-related in 63.6 % and recipient-related in the rest. Common donor-related reasons were: donor reluctance (23.5 %), negative liver attenuation index (16.2 %), anatomic variations (10.3 %), inadequate remnant liver volume (9.8 %), unacceptable liver biopsy (8.8 %), and inadequate graft volume (5.4 %). A majority of donors (82.8 %) were turned down early in the (steps 1 and 2) evaluation process. Recipient death was the most common recipient-related reason [n = 51 (43.6 %)] for not proceeding to donation. There was no donor mortality. The overall complication rate was 19.8 % and major complication rate (grade 3 or higher) was 4.4 %.

Conclusions

A stringent stepwise donor evaluation process leads to early recognition of unsuitable donors and a low complication rate.

     

Preoperative balloon dilatation of obstructed total anomalous pulmonary venous connection in a neonate.

Prompt recognition and early surgical correction are mandatory in neonates presenting with obstructed total anomalous pulmonary venous connection (TAPVC). Preoperative balloon angioplasty of obstructed TAPVC in a sick neonate is rarely reported. We describe successful short-term palliation with balloon angioplasty of a critically ill neonate with obstructed supracardiac TAPVC.     

Clinical and angiographic profile and follow-up of myocardial bridges: a study of 21 cases

Myocardial bridging describes an angiographic entity, which is any degree of systolic narrowing of a coronary artery observed in at least one angiographic projection. Among the cineangiograms of 3200 patients reviewed, there were 21 cases (19 males) of myocardial bridges--incidence of 0.6 percent. Of these, seven had hypertrophic cardiomyopathy, six had atherosclerotic coronary artery disease and remaining eight had no evidence of either. All 21 patients had myocardial bridges in proximal or mid left anterior descending coronary artery. In addition, one case of hypertrophic cardiomyopathy had whole posterior descending coronary artery under a myocardial bridge. Another case of hypertrophic cardiomyopathy had a short normal segment of 5 mm inside a long myocardial bridge of 35 mm (tandem myocardial bridges). The length of the bridges varied from 10 to 35 mm (mean 24.5 +/- 4.5 mm) and diameter stenosis during systole varied from 40-90 percent (mean 70 +/- 8%). Two patients had large saccular coronary aneurysms proximal to the muscle bridge. Four of the eight patients who had neither hypertrophic cardiomyopathy nor coronary artery disease presented with acute anterior wall myocardial infarction and three of them had regional wall motion abnormality of left descending territory. Of the six patients who had coronary artery disease, one had 60 percent left descending artery lesion and two had recanalized segments proximal to the bridge. Five of the above six patients had significant stenosis of other coronary vessels. Four patients were lost to follow-up (mean period 3.4 +/- 2 years). In the coronary artery disease group, one patient underwent coronary artery bypass graft surgery for 3-vessel disease including graft to left descending artery and one developed inferior wall myocardial infarction. The patients in the hypertrophic cardiomyopathy group and "no hypertrophic cardiomyopathy-no coronary artery disease" group were free of events at last follow-up. Long-term prognosis of isolated myocardial bridges appears to be excellent. Degree of systolic narrowing or length of myocardial bridge does not correlate with event rates on follow-up.     

Protective effect of Sida cordata leaf extract against CCl4 induced acute liver toxicity in rats

ObjectiveTo investigate the hepatoprotective potential of Sida cordata (Malvaceae) (S. cordata) in experimental rats to validate its traditional claim.MethodsWister albino rats were divided into 6 groups: Group I served as control; Group II served as hepatotoxic (CCl₄ treated) group; Group III, IV and V served as (100, 200 and 400 mg/kg b.w.) S. cordata leaf extract (SCLE) treated groups; Group VI served as positive control (Silymarin) treated group. Liver marker enzymes serum glutamate oxyloacetic transaminase, serum glutamic pyruvic transaminase, pancreatic enzymatic antioxidants superoxide dismutase (SOD), lipid peroxidation, catalase (CAT), reduced glutathione (GSH) were measured and compared along with histopathological studies.ResultsObtained results show that the treatment with SCLE significantly (P<0.05-<0.001) and dose-dependently reduced CCl₄ induced elevated serum level of hepatic enzymes. Furthermore, SCLE significantly (up to P<0.001) reduced the lipid peroxidation in the liver tissue and restored activities of defence antioxidant enzymes GSH, SOD and CAT towards normal levels, which was confirmed by the histopathological studies.ConclusionsThe results of this study strongly indicate the protective effect of SCLE against CCl₄ induced acute liver toxicity in rats and thereby scientifically support its traditional use.     

珠子草对大鼠半乳糖性白内障的抑制作用

目的:本研究旨在评价珠子草在体外及体内抑制半乳糖性白内障的作用。方法:研究珠子草提取液在体内及体外抑制半乳糖性白内障的作用。300g/L半乳糖饮食诱导半乳糖性白内障大鼠,75, 150及300mg/kg3剂量水平口服珠子草。在体外小鼠晶体培养基中掺入半乳糖(30mmol/L)建立渗透性应激,研究珠子草(720及880μg/mL)对谷胱甘肽(GSH)及山梨糖醇水平的影响。结果:在体内,珠子草显著延缓的白内障的发生和发展。除了延缓各期白内障的发展,直至试验周期结束,低剂量组未发展至IV期。在体外,880μg/mL珠子草培养晶状体显示较高浓度的GSH和山梨糖醇浓度的降低。在体内,与对照组比较,75mg/kg珠子草显著延缓了白内障的发生和发展。结论:在试验模型中珠子草延缓了白内障的发展。然而,将其延伸运用在人类预防白内障需要进一步的研究。     

Magnesium deficiency in the eosinophilia—myalgia syndrome. report of clinical and biochemical improvement with repletion

We describe a patient with the eosinophilia–myalgia syndrome (EMS) with persistent myalgias, cramping, and weakness that were not responsive to treatment. Despite a normal serum magnesium level, a loading study was performed, and the results suggested low tissue levels of magnesium. He was given parenteral magnesium and had dramatic improvement in symptoms as well as in muscle intracellular levels of this cation. After cessation of magnesium therapy the symptoms recurred, and magnesium repletion again led to an improvement in symptoms and ATP levels. Low tissue levels of magnesium, even in the setting of normal serum levels, may lead to the neuromuscular symptoms in EMS and related disorders.