Combination of narrow band UVB and topical calcipotriol for the treatment of vitiligo

BACKGROUND: Narrow band ultraviolet B (NB-UVB) phototherapy has been used successfully for the treatment of vitiligo. Recently, topical calcipotriol has also been claimed to be effective, either as monotherapy or as a part of combination therapies. OBJECTIVE: The aim of the present study was to compare the clinical efficacy of NB-UVB and NB-UVB plus topical calcipotriol in the treatment of vitiligo. METHODS: NB-UVB treatment was given to 24 patients with generalized vitiligo three times weekly. Topical calcipotriol cream was only applied to the lesions located on the right side of the body. Treatment was continued for 6 months. Treatment efficacy was evaluated by determining the average response rates of the lesions at 3-month intervals. RESULTS: The average response rates of patients receiving combination of NB-UVB plus calcipotriol and NB-UVB alone were 51 +/- 19.6% and 39 +/- 18.9%, respectively. The median cumulative UVB dose and number of UVB exposures for initial repigmentation were 6345 mj/cm(2) (range; 2930-30980) and 18 (range; 12-67) for the combination therapy, and 8867.5 mj/cm(2) (range; 2500-30980) and 24 (range; 15-67) for the narrow band UVB therapy, respectively. CONCLUSIONS: These findings indicate that concurrent topical calcipotriol potentates the efficacy of NB-UVB in the treatment of vitiligo. This combination not only provides earlier pigmentation with lower total UVB dosage and less adverse UVB effects, but also reduces the duration and cost of treatment as well.     

High platelet count associated with venous thromboembolism in cancer patients: results from the Vienna Cancer and Thrombosis Study (CATS)

Summary.  Background:  In cancer patients, laboratory parameters that predict venous thromboembolism (VTE) are scarce. Increased platelet count has been found to be a risk factor for VTE in cancer patients receiving chemotherapy (CHT). We have assessed high platelet count as a risk predictor for VTE in patients with cancer undergoing discriminative anti-cancer treatments and investigated whether platelet count correlates with thrombopoietin (TPO) levels. Design and methods:  The Cancer and Thrombosis Study (CATS) is an ongoing prospective observational study of patients with newly diagnosed cancer or progression of disease, which started in October 2003. Occurrence of VTE and information on the patients' anti-cancer treatment during follow-up were recorded. Results: Between October 2003 and February 2008, 665 patients with solid tumors were included (314 female/351 male, mean age 62 years). VTE occurred in 44 patients (18 female/26 male, mean age 62 years). The cumulative probability of VTE after 1 year was 34.3% in patients with a platelet count (PC) above the 95th percentile representing 443 × 10⁹/L compared with 5.9% in those below 443 × 10⁹/L. High platelet count [hazard ratio (HR): 3.50, 95% confidence interval (CI): 1.52–8.06, P  = 0.0032], soluble P-selectin [HR: 2.66, 95% CI: 1.42–4.96, P  = 0.0021] and surgery [HR: 4.05, 95% CI: 1.74–9.46, P  = 0.0012] were statistically significant risk factors for VTE in multivariable analysis along with leucocyte count, age, gender, radio- and CHT. We found no correlation between platelet count and TPO levels. Conclusions:  High PC is a clinically important, independent risk predictor for VTE in cancer patients. PC was not found to be associated with TPO levels.     

补肾方药归经与实验性骨质疏松靶器官信号转导分子Smad2的表达

目的:观察补肾方药归经与实验性骨质疏松靶器官信号转导分子Smad2的基因表达,从基因水平研究中医归经理论,为靶向给药提供依据。方法:实验于2004-06/2006-11在河北医科大学中西医结合基础实验室完成。实验分组:选择3个月龄健康雌性SD大鼠(未曾交配)90只,体质量(300±20)g。常规喂养1周后,随机数字表法分成7组:正常对照组、骨质疏松模型组、补肾方药口服组、肾经外贴组、膀胱经外贴组、依普拉封口服组、非经非穴位外贴组,其中正常对照组和骨质疏松模型组每组20只,其余每组各10只。实验处理:除正常对照组喂正常饲料,自由饮水外,其余各组均喂食低钙饲料,饮用蒸馏水,每周2次在大鼠大腿内侧肌肉注射地塞米松1mg/kg体质量,5周后建立骨质疏松模型。实验评估:造模后,用抗骨松穴位贴剂分别外贴肾经和膀胱经穴位、非经非穴位、并与口服补肾方药比较治疗骨质疏松,以双能X线骨密度仪检测连续给药16周后大鼠离体股骨骨密度,采用逆转录-聚合酶链反应、蛋白免疫印迹杂交方法分别检测Smad2的mRNA、蛋白表达,观察其治疗效果。结果:纳入90只大鼠,在实验第5周时,正常对照组、骨质疏松模型组分别取10只,用于验证造模成功,70只进入结果分析。①给药16周后,与骨质疏松模型组比较,补肾方药口服组、肾经外贴组、膀胱经外贴组、依普拉封口服组的股骨骨密度明显增加[(0.161±0.016),(0.206±0.028),(0.196±0.023),(0.202±0.015),(0.205±0.023)g/cm2,P均<0.01]。②应用补肾中药防治16周后,与骨质疏松模型组比较,补肾方药口服组、肾经外贴组、膀胱经外贴组、依普拉封口服组Smad2mRNA的表达明显上调(0.517±0.031,0.524±0.033,0.596±0.033,0.592±0.021,0.583±0.032,P<0.01);Smad2蛋白表达亦明显增强,差异显著(50.901±2.205,71.802±2.100,72.352±2.306,74.012±2.145,73.802±2.203,P<0.01)。结论:①补肾方药通过口服和外贴穴位两种不同途径均发挥“归经”作用,引起靶器官骨组织上调Smad2的表达而有效改善骨密度。②Smad2mRNA表达及蛋白水平的下调可能是原发性骨质疏松症发生的重要机制之一。     

补肾方药归经与实验性骨质疏松靶器官信号转导分子Smad4的表达

目的:观察补肾方药归经与实验性骨质疏松靶器官信号转导分子Smad4的基因表达,从基因水平研究中医归经理论,为靶向给药提供依据。方法:实验于2004-06/2007-05在河北医科大学中西医结合基础实验室完成。①实验分组:选择3月龄健康雌性SD大鼠(未曾交配)70只,体质量(300±20)g。常规喂养1周后,随机数字表法分成7组:正常对照组、病理模型组、补肾方药口服组、肾经外贴组、膀胱经外贴组、依普拉封口服组、非经非穴位外贴组,每组10只。②实验处理:除正常对照组喂正常饲料,自由饮水外,其余各组均喂食低钙饲料,饮用蒸馏水,每周2次在大鼠大腿内侧肌肉注射地塞米松1mg/kg体质量,5周后建立骨质疏松模型。造模后,补肾方药口服组将补肾方药总成分按8g/kg体质量灌喂给药;依普拉封口服组按10mg/kg体质量灌喂给药;正常对照组、模型组每天灌胃等体积的生理盐水,每天上午给药;膀胱经外贴组大鼠在膀胱经取肾俞、飞扬穴;肾经外贴组大鼠在肾经选太溪、大钟穴;非经非穴位外贴组大鼠在大腿内侧肌肉丰厚处选非经非穴位;于脱毛区贴上相应的膏剂,左右交替进行,1次/d。③实验评估:检测连续给药16周后的血清钙、磷、碱性磷酸酶、雌二醇、睾酮,以双能X线骨密度仪检测腰椎骨密度,采用反转录-聚合酶链反应、蛋白免疫印迹杂交方法分别检测Smad4的mRNA、蛋白表达。结果:70只大鼠均进入结果分析。①血清碱性磷酸酶、雌二醇、睾酮、骨密度:给药16周后,与病理模型组比较,补肾方药口服组、肾经外贴组、膀胱经外贴组、依普拉封口服组的血清碱性磷酸酶、雌二醇、睾酮、骨密度明显增加(P均<0.01)。②Smad4mRNA和Smad4蛋白的表达:应用补肾中药防治16周后,与病理模型组比较,补肾方药口服组、肾经外贴组、膀胱经外贴组、依普拉封口服组Smad4mRNA的表达明显上调(P<0.01);Smad4蛋白表达亦明显增强,差异有显著性(P<0.01)。结论:①补肾方药通过口服和外贴穴位两种不同途径给药均发挥"归经"作用,使靶器官骨组织上调Smad4的表达而有效改善骨密度。②Smad4mRNA表达及蛋白水平的下调可能是原发性骨质疏松症发生的重要机制之一。     

Body mass index centile charts to assess fatness of British children

Body mass index (BMI) relates weight to height and reflects the shape of a child, but because of age dependency it has not been used conventionally for the estimation of fatness in children. From measurements of Tayside children (n = 34,533) centile charts were constructed for BMI (wt/ht2) from the raw data of height and weight, using Cole's LMS method for normalised growth standards. These data were compared with the only available European BMI charts published from data of French children obtained over a period of 24 years from 1956-79. British children appear to be 'fatter'. Within a subgroup (n = 445) the BMI values were correlated with estimations of body fat, for boys and girls, from skinfold thickness (r = 0.8 and 0.81) and bioelectrical impedance (r = 0.65 and 0.7). The limits of acceptable BMI have yet to be defined.     

不同结构松质骨填充植入股骨头负重区缺损的有限元分析

目的:应用三维有限元分析法比较松质骨粒和结构性松质骨块植骨重建股骨头负重区缺损对股骨近段应力分布的影响。方法:实验于2005-06/2006-03在解放军总医院骨科研究所完成。采用Taddei的基于连续CT断层构建的人股骨三维有限元模型,在ANSYS5.7分析软件中划分52350个四面体单元,模拟单腿站立时髋臼在股骨头表面负重区施加的面载荷,合力指向股骨头形心,与股骨干长轴的夹角成25°,大小2100N,分别在正常状态时、股骨头负重区缺损时及原位松质骨植入、异位松质骨植入和松质骨粒植入时计算股骨近段的应力分布。结果:①正常股骨近段的应力峰值集中在股骨颈上下方,股骨头表面的应力峰值为2.12MPa,深部应力高于表面应力峰值为6.37MPa。②负重区缺损模型下,股骨头表面应力增高,峰值达10.39MPa,股骨头内部应力低于表面。③在松质骨粒植入后,表面应力有所下降,但仍然高于内部,应力峰值达8.55MPa。④异位结构性松质骨植入后表面应力峰值为2.43MPa,与正常时差别不大;而原位松质骨块植入后的应力曲线几乎与正常应力曲线重合。结论:结构性松质骨块的植入对恢复股骨头表面及内部的应力水平要优于松质骨粒。     

A single centre experience in circumcision of haemophilia patients: Izmir protocol

Summary. Haemophiliacs and their families consider that circumcision is a very important step to become a member of society and it is a social obligation for men in Turkey. Although bleeding risk is high, almost all haemophiliacs would like to be circumcised in Turkish society. The aim of this study was to evaluate our experience in circumcision of haemophilia patients and define efficacy, safety and complication rates of our protocol, called ‘Izmir protocol’. In this study, we retrospectively reviewed medical records of 50 patients with haemophilia who underwent circumcision at our hospital according to Izmir protocol between 1996 and 2009. Oral tranexamic acid and fibrin glue were used in all children. One hour before the operation, first dose of factor concentrate was given. After reaching a plasma factor level of around 90–100%, the prepuce was incised circumferentially and excised using Gomco clamp or open technique under general anaesthesia. Intermittent injections of factor concentrate were given every 12 for 48 h. While the first two doses were given at higher amount to achieve or continue plasma factor level at 90–100%, in the last three doses, the aim was to maintain the plasma factor level at 50–60%. Forty‐eight hours after the circumcision, patients were discharged. Three patients (6%) showed bleeding complication and all were resolved easily. All had at least one excuse from the protocol (Lower doses of factor concentrates was used in 2, tranexamic acid was not used in 2). Izmir protocol is safe, cheap and easy to carry out.     

Suppressor activity of spleen cells in drug-induced immunologic tolerance

Tolerance to sheep's red blood cells (SRBC) was induced in (CBA×C57BL/6)F₁ mice by a single intraperitoneal injection of 6×10⁹ SRBC followed by injection of 100–200 mg/kg cyclophosphamide 44–46 h later. Spleen cells of tolerant mice, obtained at various times (12–26 days) after induction of tolerance, when injected into intact syngeneic recipients, did not depress their immune response to SRBC. Unlike intact mice, tolerant mice were unable to produce suppressor cells after a single immunization with SRBC. Only if three additional injections of large doses (6×10⁹) of SRBC were given to the tolerant mice did their spleen cells acquire the ability to inhibit the immune response on injection into normal mice. It is postulated that the absence of suppressor cells on induction of immunologic tolerance by means of cyclophosphamide is due to clonal elimination. Suppressor cells may arise in tolerant animals under the influence of intensive antigenic stimulation, leading to deepening of the state of tolerance as a result of additional injections of SRBC.Laboratory of Immunogenetics, Institute of Medical Genetics, Academy of Medical Sciences of the USSR, Moscow. (Presented by Academician of the Academy of Medical Sciences of the USSR N. N. Zhukov-Verezhnikov.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 86, No. 11, pp. 558–560, November, 1978.     

Triaging dysphagia: nurse screening for dysphagia in an acute hospital

Aims and objectives. To (1) develop a dysphagia screening tool to triage all patients at risk of aspiration/dysphagia on admission to acute hospital wards, (2) evaluate tool reliability, (3) evaluate nursing compliance and (4) develop a robust dysphagia training programme. Background. Failure to diagnose dysphagia has significant medical and economic costs. Dysphagia screening reduces pneumonia threefold. Most nurse‐screening tools have focused on stroke. However, many other conditions are associated with dysphagia. A multidisciplinary team developed a nurse‐administered, evidence‐based swallow screening tool for generic acute hospital use. Design. Prospective, quasi‐experimental. Methods. Nurses were assessed for knowledge pre‐ and post‐training. All patients were nurse‐screened for dysphagia on admission. All patients were reviewed by speech pathologists to determine screening accuracy. Results were not blinded. The one page tool encompassed (1) diagnostic categories, (2) patient/carer interview, (3) dysphagia indicators and (4) if applicable, water swallow test. Results. Thirty‐eight nurses participated in a seven‐week study; 442 patients were screened on two general medical wards. Three speech pathologists counter‐assessed each patient by clinical examination or chart review. Sensitivity was 95%; specificity was 97%. Positive predictive value was 92%; negative predictive value was 98%. 3·4% of clinical screening decisions were incorrect. Compliance rate was 85%. Conclusions. Caution is advised in interpretation of the results due to lack of blinding. Initial results suggest that the dysphagia screening tool is a quick and robust tool for triaging individuals with dysphagia. Training is critical to successful screening. Relevance to clinical practice. Twenty‐five to 30% of acute hospitalised individuals have dysphagia. All adult acute patients are screened for dysphagia using the Royal Brisbane and Women’s Hospital dysphagia screening tool. Patients are triaged into categories of ‘those requiring additional specialist intervention’ and ‘those who can proceed directly to regular diets and liquids’. Improved quality of care and cost savings is likely.