Chemical cleaning of titanium tray for reconstructive surgery

AIMS: To find out the extent of chemical contamination on the surface of titanium wrought mesh before and after swaging, and to assess the effectiveness of cleaning off these contaminants by various chemical methods. MATERIALS AND METHODS: Qualitative analysis of the surfaces of 6 wrought titanium meshes by scanning electron microscopy (EM) and radiological microanalyser. One of these meshes was subjected to experimental cleaning by different methods. Qualitative chemical analysis of 20 titanium trays fabricated for clinical use before and after acid cleansing. RESULTS: All 6 titanium meshes had surface contaminants, with silicon being the most common. The effective cleaning methods were chemical cleaning with Titaclean, mechanical trimming, or polishing with diamond paste. The 20 swaged titanium trays were effectively cleaned with either Titaclean or Chemi-Polish solution. CONCLUSION: Previously unknown surface contamination was common on wrought titanium mesh. Ultrasonic cleansing with Titaclean or Chemi-Polish effectively removed most of the contaminants on the titanium trays before they were implanted.     

Association of a polymorphism in the lipin 1 gene with systolic blood pressure in men

BACKGROUND: Lipin 1 plays a role in abdominal obesity, insulin resistance, and hypertriglyceridemia. The gene is located at 2p25.1, a susceptibility locus for hypertension. We studied the association of tagging single-nucleotide polymorphisms (SNPs) in the lipin 1 (LPIN1) gene with hypertension and blood pressure. METHODS: Twelve tagging SNPs from the HapMap database were genotyped using Sequenom MassArray in 268 hypertensive subjects and 407 normotensive controls, of whom 268 matched the cases in age and sex. RESULTS: None of the tagging SNPs were found to be associated with hypertension after correcting for multiple testing, although carriers of the minor allele of rs10520097 had nominally lower odds for hypertension (P = 0.014). After excluding subjects who were on antihypertensive medications, the minor allele of rs10495584 was nominally associated with lower mean systolic and diastolic blood pressures in men (121.1 +/- 14.2 and 76.3 +/- 10.2 mm Hg vs. 127.4 +/- 15.2 and 80.1 +/- 10.5 mm Hg, P = 0.002 and 0.007, respectively), but not in women (P > 0.05). The association of rs10495584 with systolic blood pressure in men remained significant after correcting for multiple testing and adjustment for age, waist circumference, insulin resistance, triglyceride, and high-density lipoprotein (HDL) cholesterol (beta = -0.158, P = 0.005). An analysis of statistically similar SNPs (ssSNPs) in the regions surrounding rs10495584 suggested that its effect may be caused by its high linkage disequilibrium (LD) with the SNP, rs11524, in which the major allele forms an exonic splicing silencer sequence. CONCLUSION: Our study provides further evidence that lipin 1 may play a role in blood pressure regulation, especially in men.     

A case of Sengstaken-Blakemore tube-induced esophageal rupture repaired by endoscopic clipping

A 57-year-old man was admitted to another hospital for hematemesis due to heavy drinking. A Sengstaken-Blakemore tube was inserted and the patient was transferred to our hospital. The patient's ensuing movements inadvertently caused an esophageal rupture 2.5 cm in size. Since the patient's condition was stable, treatment via endoscopic repair using metallic clips was chosen over emergency surgery. Two hemoclips were fixed at the ends of the ruptured area; by employing an endoscopic detachable snare, the ruptured area was carefully repaired with 10 metallic clips. As a result, the esophageal rupture could be successfully repaired by endoscopic procedure rather than performing surgery.     

The meaning of pain relief in a clinical trial.

Data from 207 subjects in the early postoperative period in a controlled clinical trial were used to examine the factors that contribute to global ratings of satisfaction with pain relief. Prerecovery to postrecovery period change scores in pain intensity were not significantly associated with level of satisfaction with pain relief. However, endpoint pain intensity, average pain intensity, recall rating of maximum pain, and actual maximum pain during the immediate postoperative period all predicted relief satisfaction. Of these predictors, average pain and change in pain were associated with relief satisfaction when controlling for all the predictors. The average pain levels reported by patients who rated themselves as being "very satisfied" and "somewhat satisfied" with the level of pain relief were 32.86 (on a 0 to 100 visual analogue scale [VAS]) and 40.00, respectively. Patients who were "slightly satisfied," "neither satisfied nor dissatisfied," and "slightly," "somewhat," and "very dissatisfied" reported similar levels of average pain during the recovery period (range = 51.37-56.32). The findings indicate that the primary variable related to relief satisfaction following surgery during the immediate postoperative period is an average of the pain intensity experienced during this time period. PERSPECTIVE: In order to be "very satisfied" with pain relief during the postoperative period, patients are not required to experience no pain. Rather, the study findings suggest that mild pain averaging less than 40 on a 0 to 100 VAS is adequate. However, moderate pain during the early recovery period averaging about 50 or more on a 0 to 100 VAS appears to be associated with dissatisfaction with pain relief.     

Advantages of blood pressure optimization

Lowering blood pressure (BP) reduces cardiovascular events, but aggressive BP management may not be advantageous. Optimal BP control (target: < 120/ 80 mm Hg) and conventional BP control (target: < 140/90 mm Hg) were compared in patients with hypertension in terms of target-organ damage and tolerability. A total of 23 patients with hypertension were randomly assigned to optimal versus conventional therapy for 6 months. Therapy was initiated with lercanidipine 10 mg/day. For BP control, the dose could be doubled or other drugs added. Three indices of target-organ damage were studied: left ventricular mass (LVM) index, flow-mediated dilatation (FMD) of the brachial artery, and 24-hour urinary albumin excretion. The BP decreased markedly by 21.3±3.4/13.2±1.7 mm Hg in the conventional therapy group and by 26.6±3.6/17.9±1.5 mm Hg in the optimal therapy group. Diastolic BP was significantly lower, by 4.7±2.3 mm Hg, in the optimal therapy group (P < .05). Ambulatory BP was also decreased in both groups. There was no significant change in LVM or FMD in either group. Baseline LVM index and FMD values were correlated with systolic BP (r=0.51, P=.02; r=0.54, P=.009). In the optimal therapy group, urinary albumin excretion increased significantly (P=.04). Plasma levels of B-type natriuretic peptide (BNP) decreased with antihypertensive therapy (P=.03). Treatment was well tolerated, and none of the patients withdrew from the study. There was no significant difference in adverse events between the 2 groups. Optimization of BP is feasible, safe, and well tolerated; however, a larger study of longer duration may be needed to demonstrate improvements in LVM and endothelial function with conventional versus optimal therapy.     

Osteoporosis in Primary Biliary Cirrhosis: A Randomized Trial of the Efficacy and Feasibility of Estrogen/Progestin

The optimal therapy for the prevention and treatment of osteoporosis in primary biliary cirrhosis (PBC) is unknown. Hormone replacement therapy (HRT) prevents osteoporosis, but may promote cholestasis. We performed a double-blind, randomized, placebo-controlled trial of transdermal estrogen/progestin in postmenopausal women with PBC. The 24-month study enrolled 31 patients, but trial uptake was limited and treatment arm dropout was significant. Placebo-treated patients had a higher percentage loss in femoral neck bone mineral density than actively treated patients (−3.76 ± 1.37% versus 0.21 ± 1.01%, respectively, P = .058). New fractures occurred in 2 patients on placebo, and in no patients on treatment. The mean monthly increase in bilirubin was not significantly different between groups, but individual data suggest HRT may worsen cholestasis. In conclusion, women with PBC have strong feelings about HRT, and recruitment for this intervention is difficult. Transdermal estrogen/progestin likely provides protection against bone loss in PBC patients, but may worsen cholestasis. Supported by Canadian Institute of Health Research Grant PA-12412. Transdermal estrogen/progestin and placebo supplied by Novartis.     

Hypoadiponectinemia as a predictor for the development of hypertension: a 5-year prospective study

Low circulating levels of adiponectin, an adipokine with insulin-sensitizing, antiatherogenic, and anti-inflammatory properties, are found in hypertensive patients. Adiponectin replenishment ameliorated hypertension in adiponectin-deficient mice or obese, hypertensive mice with hypoadiponectinemia, suggesting an etiologic role of adiponectin in hypertension. We aimed to determine, in this 5-year prospective study, whether hypoadiponectinemia could predict the development of hypertension in a nondiabetic Chinese cohort. A total of 577 subjects (249 men and 328 women) were recruited from the population-based Hong Kong Cardiovascular Risk Factor Prevalence Study and prospectively followed up for 5 years. The relationship of serum adiponectin with the development of hypertension (sitting blood pressure >or=140/90 mm Hg) was investigated in a nested case-control study consisting of 70 subjects who had developed hypertension on follow-up and 140 age- and sex-matched control subjects who were normotensive both at baseline and at year 5. At baseline, serum adiponectin level in the lowest sex-specific tertile was more likely to be associated with hypertension (P=0.003 versus the highest tertile, after adjusting for age, body mass index, fasting insulin, and high-sensitivity C-reactive protein). At year 5, baseline serum adiponectin was a significant independent predictor of incident hypertension in the nested case-control study (P=0.015; age adjusted), together with mean arterial pressure (P<0.001), high-sensitivity C-reactive protein (P=0.018), and body mass index (P=0.004). Normotensive subjects with baseline serum adiponectin levels in the lowest sex-specific tertile had an increased risk of becoming hypertensive (adjusted odds ratio: 2.76; 95% CIs: 1.06 to 7.16; P=0.037 versus highest tertile). Our data suggest that hypoadiponectinaemia may be involved in the pathogenesis of hypertension in humans.