Processed blood volume impacts clinical efficacy in patients with ulcerative colitis undergoing adsorptive depletion of myeloid lineage leucocytes

Background  

Hitherto, therapeutic depletion of granulocytes and monocytes by adsorption (GMA) has been associated with significant and insignificant efficacy in patients with ulcerative colitis (UC). Further, the processed blood volume in one GMA session has been fixed at 30 mL/min × 60 min, regardless of patients’ body weight (BW). We were interested to see the efficacy and safety of GMA when administered in relation to patients’ BW.     

Prevalence and associated metabolic factors of nonalcoholic fatty liver disease in the general population from 2009 to 2010 in Japan: a multicenter large retrospective study

Background

The prevalence of nonalcoholic fatty liver disease (NAFLD) has been increasing. This study aimed to assess the recent prevalence of NAFLD and to predict the prevalence of nonalcoholic steatohepatitis (NASH) with liver fibrosis using established scoring systems in the general population.

Methods

A cross-sectional study was conducted among 8352 subjects who received health checkups from 2009 to 2010 in three health centers in Japan. Subjects with an intake over 20?g of alcohol/day or with other chronic liver diseases were excluded. Fatty liver was detected by ultrasonography. The probability of NASH with advanced fibrosis was calculated according to the body mass index, age, ALT, and triglyceride (BAAT) and FIB-4 (based on age, aspartate aminotransferase and alanine aminotransferase levels, and platelet counts) indices.

Results

A total of 5075 subjects were enrolled. The overall prevalence of NAFLD was 29.7%. There was a significant threefold difference in the mean prevalence between males (41.0%) and females (17.7%). This prevalence showed a linear increase with body mass index, triglycerides, and low-density lipoprotein cholesterol regardless of threshold values, even without obesity. The estimated prevalence of NASH according to the BAAT index ≥3 was 2.7%, and according to the FIB-4 index it was 1.9%.

Conclusions

The prevalence of NAFLD has increased in the general population, especially in males. There is a linear relationship between the prevalence of NAFLD and various metabolic parameters, even in nonobese subjects. The prevalence of NASH with advanced fibrosis is estimated to be considerably high in subjects with NAFLD.     

Association between ApoE phenotypes and telomere erosion in Alzheimer's disease

Although several reports suggest that Alzheimer's disease (AD) is associated with shortened telomere length, the clinical relevance of this has not yet been fully elucidated. This study was conducted to clarify the correlation of telomere length with clinical characteristics and ApoE phenotypes in 74 AD patients. Telomere length was determined from genomic DNA extracted from whole blood by quantitative real-time polymerase chain reaction. We found no significant difference in telomere length between the AD and non-dementia elderly control (n = 35) groups. Furthermore, no significant correlation was found among telomere length and the severity of cognitive decline and disease duration, age, or gender difference. However, telomere length was significantly shorter in AD patients with the ApoE4 homozygote than in those with the ApoE4 heterozygote (p < .001) and noncarriers (p < .001). These findings suggest that shortened telomere length may be associated with the ApoE4 homozygote in AD patients.     

Effects of telmisartan on cognition and regional cerebral blood flow in hypertensive patients with Alzheimer's disease

Aim: Recent studies have shown that some antihypertensive medications are associated with a significant reduction in the incidence of Alzheimer's disease (AD). However, it remains uncertain whether antihypertensive drugs may have a preventive effect on cognitive decline in patients with AD. We investigated the effects of telmisartan, an angiotensin II type 1 receptor blocker with peroxisome proliferator‐activated receptor γ‐stimulating activity, on cognition and regional cerebral blood flow (rCBF) in elderly hypertensive patients with AD. Methods: A total of 20 patients with probable AD and essential hypertension were randomly assigned to the telmisartan group (n = 10, 40–80 mg daily) or the amlodipine group (n = 10, 5–10 mg daily) for 6 months. Results: The groups had a similar significant reduction in systolic and diastolic blood pressure after treatment. The telmisartan group did not show any changes in cognitive function test scores, while the amlodipine group showed significantly higher scores on the AD Assessment Scale‐Cognitive Subscale (Japanese version). Analysis of covariance to analyze treatment effect revealed that the telmisartan group showed increased rCBF in the right supramarginal gyrus, superior parietal lobule, cuneus, and lingual gyrus compared with the amlodipine group, while the amlodipine group showed increased rCBF only in the right cingulate gyrus compared with the telmisartan group at 6 months. Conclusion: These findings suggest that telmisartan may have additional benefits and be useful for the treatment of elderly hypertensive patients with AD. Geriatr Gerontol Int 2012; 12: 207–214.     

Safety and response to influenza vaccine in patients with systemic-onset juvenile idiopathic arthritis receiving tocilizumab

Objective

We investigated the safety and efficacy of administering influenza vaccines to patients with systemic-onset juvenile idiopathic arthritis (sJIA) treated with tocilizumab.

Patients and methods

The subjects were 27 sJIA patients treated with tocilizumab and 17 healthy age- and sex-matched volunteers. Serum samples were collected prior to and 4–7 weeks after vaccination. Hemagglutination inhibition values of the vaccine were taken as the antibody titers. The duration of tocilizumab administration and the daily doses of prednisolone per unit body weight were analyzed to identify factors affecting the responses of the sJIA patients to influenza vaccination. We questioned all the subjects about whether they had contracted influenza and whether they had had adverse reactions to the influenza vaccination. We compared steroid doses in sJIA patients before and after vaccination to document any worsening of the underlying disease.

Results

The efficacy of influenza vaccination did not differ significantly between the sJIA group and the healthy controls. The duration of tocilizumab administration did not affect the response of the sJIA patients to the influenza vaccination. None of the sJIA patients experienced either severe adverse reactions or disease exacerbation after the influenza vaccination.

Conclusion

We found that sJIA patients treated with tocilizumab could be effectively and safely immunized with the influenza vaccine.     

Transvertebral anterior cervical foraminotomy: midterm outcomes of clinical and radiological assessments including the finite element method

Purpose

The aim of this study was to compare the clinical features, radiological changes, biomechanical effects, and efficacy in patients treated by transvertebral anterior foraminotomy. Preservation of segmental motion and avoidance of adjacent segment degeneration are theoretical advantages of transvertebral anterior foraminotomy. In practice, this procedure is minimally invasive and has shown good clinical results, especially in patients with unilateral cervical radiculopathy.

Method

We conducted a retrospective minimum 2-year follow-up study of the cervical spine of patients treated by transvertebral anterior foraminotomy at our institution. Radiological outcomes, which were estimated by measuring disc and functional spinal unit heights, and the angle and range of motion (ROM) from C2 to C7 of the functional spinal unit and adjacent segments were evaluated. Furthermore, a three-dimensional finite element method was used to biomechanically analyze the strength of the postoperative vertebral body.

Results

Between 2004 and 2009, 34 patients underwent surgery. The improvement rate was 94.2 %. The average flexion–extension ROM from C2 to C7 was 36.6 ± 16.6°. On plain radiographs, the disc height and ROM and height of the functional spinal unit in the operated segment were not significantly decreased relative to the preoperative levels. The finite element method also revealed that there was no difference in strength between the pre- and postvertebral bodies.

Conclusions

These results demonstrate that biomechanical stability was achieved. Transvertebral anterior cervical foraminotomy did not limit motion in the operated and adjacent segments and did not cause a significant decrease in disc and vertebral heights after surgery.     

Congenital prepubic sinus associated with a urachal remnant: report of a case

Congenital prepubic sinus is a rare congenital anomaly situated in the midline of the lower abdomen. We report a case of congenital prepubic sinus, closely associated with a urachal remnant. Preoperative magnetic resonance imaging showed clearly that the sinus tracked the urachus caudally. This finding supports the theory that the anomaly is caused by abnormal remnant tissue originating from the cloacal membrane, which tracks the allantois duct caudally along with fetal longitudinal growth.     

Innervation pattern at the undersurface of the extensor carpi radialis brevis tendon in recalcitrant tennis elbow

Purpose

We investigated the general, sensory, and sympathetic innervation patterns at the undersurface of the extensor carpi radialis brevis (ECRB) origin in patients with recalcitrant tennis elbow.

Methods

Eight elbows in eight consecutive patients (6 females and 2 males) with tennis elbow who underwent arthroscopic surgery were included in this study. The mean age was 45 years (38–66 years), and the mean duration of symptoms before surgery was 23 months (13–52 months). Operative treatment consisted of an arthroscopic inspection and debridement of the ECRB origin. Control tissues were obtained from biopsy of the ECRB capsule in two patients with osteochondritis dissecance of the capitellum who underwent arthroscopic resection of loose bodies. The tissue specimens were investigated immunohistochemically with antibodies delineating general (PGP9.5), sensory (SP/CGRP), and sympathetic (NPY) nerve patterns.

Results

In the non-tendinosis control tissue, SP/CGRP and NPY immunoreactions were heterogeneously distributed in association with blood vessels. Pathologic evaluation of the biopsy tissue showed atypical fibrous granulation containing numerous vessels and nerve structures in all eight patients. Marked reactions to PGP 9.5 took the form of nerve fibers associated with arteries and arterioles in the atypical granulation. Most of the perivascular innervation was found to express NPY. The immunoreactions for SP and CGRP were invariably weak.

Conclusion

Increased perivascular sympathetic innervation accompanied with loss of sensory innervation at the undersurface of the ECRB tendon may play a role in chronic pain generation in recalcitrant tennis elbow.

Level of evidence

Diagnostic, Level IV.     

Analysis of effectiveness of therapeutic exercise for knee osteoarthritis and possible factors affecting outcome

Background

There are numerous reports and evidences to suggest that exercise therapy is effective for knee osteoarthritis (knee OA). However, there is a lack of sufficient research concerning the factors influencing its application and effectiveness. The purposes of this study were to evaluate effects of the mode of treatment delivery on the improvement of symptoms in knee OA, and to analyze potential risk factors affecting improvement after exercise therapies.

Methods

The 209 women applicants diagnosed with knee OA were randomly allocated into either a group performing group exercise in a class or a group performing home exercise. The 90 min exercise program was performed under the guidance of physiotherapists as a group exercise therapy. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) of the subjects of both groups before and after intervention was compared to examine the effect of exercise therapy. In addition, body mass index, knee range of motion (ROM), the femorotibial angle from radiographs, OA severity from Kellgren–Lawrence grade, and meniscus abnormality and subchondral bone marrow lesions from MRI findings were statistically analyzed as factors that may affect exercise therapy.

Results

A significantly greater improvement in WOMAC was observed in the subjects of group exercise (81 subjects) as compared with the subjects of home exercise (122 subjects). There was a significantly high proportion of subjects with knee flexion contracture among the subjects participating in group exercise that showed only minor symptom improvement (p < 0.05). In addition, exercise therapy proved to be highly effective for subjects with limited quadriceps muscle strength (p < 0.05).

Conclusions

When prescribing exercise therapy for knee OA, evaluation of a subject’s ROM and muscle strength is important in deciding whether to commence exercise therapy and what type of exercise therapy to apply; it is also important in predicting the effect of exercise therapy.