Relationship between insulin resistance and increased carotid artery intima-media thickness in non-diabetic kidney disease patients

Objective To evaluate the relationship of insulin resistance (IR) and carotid artery intima-media thickness (CA-IMT), plaque status in non-diabetic non-dialysis chronic kidney disease (CKD) patients with different stages. Methods One hundred and seventeen non-diabetes non-dialysis CKD patients were enrolled into this cross-sectional observational study. Insulin resistance index (HOME-IR) was assessed by the homeostasis model assessment. Patients with HOME-IR≥1.73 were defined as insulin resistance. And patients with CA-IMT≥0.9 mm were defined as thickening. The blood pressure measurement, heart Doppler ultrasound, bilateral carotid artery ultrasound examination, blood biochemistry and urine protein test were performed, eGFR was calculated by EPI formula. Results The prevalence of IR was 47.01% in 117 non-diabetic non-dialysis CKD patients, and it was 35.71%, 50.00% and 54.55% in eGFR≥60ml•min-1•(1.73 m2)-1 group, 30≤eGFR＜60ml•min-1•(1.73 m2)-1 group, and eGFR＜30ml•min-1•(1.73 m2)-1 group separately. In eGFR＜30ml•min-1•(1.73 m2)-1 group, cystain C, homocysteine, parathyroid hormone, Scr, BUN, uric acid, interventricular septal thickness, left ventricular dimension, left ventricular posterior wall thickness were significantly higher than that in the other two groups (P＜0.01), while the level of hemoglobin was significantly lower (P＜0.01); then the levels of serum albumin and systolic pressure were higher than that in the eGFR≥60ml•min-1•(1.73 m2)-1 group, however, the levels of total cholesterol and low-density lipoprotein-cholesterol were lower than that in the eGFR≥60ml•min-1•(1.73 m2)-1 group. Correlation analysis showed that insulin resistance index was significantly correlated with CA-IMT (r=0.444, P=0.006）in the eGFR＜30ml•min-1•(1.73 m2)-1 group, however, there wasn’t correlation in other two groups. And although insulin resistance wasn’t correlated with soft plaque, it was significantly correlated with hard plaque (χ2=6.476, P=0.011) in the eGFR＜30ml•min-1•(1.73 m2)-1 group. The Logistic regression analysis results displayed aging increase was the independent risk factor of the CA-IMT thickening for non-diabetes non-dialysis CKD patients but not insulin resistance. Conclusions HOMA-IR is correlated with CA-IMT and hard plaque when eGFR＜30ml•min-1•(1.73 m2)-1 in non-diabetes non-dialysis CKD patients. However, the insulin resistance isn’t the independent risk factor of the CA-IMT thickening for non-diabetes non-dialysis CKD patients.     

Plasmacytoid variant urothelial bladder cancer: Is it time to update the treatment paradigm?

ObjectivesPlasmacytoid variant (PCV) urothelial cancer (UC) of the bladder is rare, with poor clinical outcomes. We sought to identify factors that may better inform expectations of tumor behavior and improve management options in patients with PCV UC.Materials and methodsA retrospective analysis of the Indiana University Bladder Cancer Database between January 2008 and June 2013 was performed comparing 30 patients with PCV UC at cystectomy to 278 patients with nonvariant (NV) UC at cystectomy who underwent surgery for muscle-invasive disease. Multivariable logistic regression was used to assess precystectomy variables associated with non–organ-confined disease at cystectomy and Cox regression analysis to assess variables associated with mortality.ResultsPatients with PCV UC who were diagnosed with a higher stage at cystectomy (73% pT3-4 vs. 40%, P = 0.001) were more likely to have lymph node involvement (70% vs. 25%, P<0.001), and positive surgical margins were found in 40% of patients with PCV UC vs. 10% of patients with NV UC (P<0.001). Median overall survival and disease-specific survival were 19 and 22 months for PCV, respectively. Median overall survival and disease-specific survival had not been reached for NV at 68 months (P<0.001). Presence of PCV UC on transurethral resection of bladder tumor was associated with non–organ-confined disease (odds ratio = 4.02; 95% CI: 1.06–15.22; P = 0.040), and PCV at cystectomy was associated with increased adjusted risk of mortality (hazard ratio = 2.1; 95% CI: 1.2–3.8; P = 0.016).ConclusionsPCV is an aggressive UC variant, predicting non–organ-confined disease and poor survival. Differentiating between non–muscle- and muscle-invasive disease in patients with PCV UC seems less important than the aggressive nature of this disease. Instead, any evidence of PCV on transurethral resection of bladder tumor may warrant aggressive therapy.     

Diagnosis and treatment of vertebral hemangiomas with neurologic deficit: a report of 29 cases and literature review

Background contextVertebral hemangiomas (VHs) are called benign tumors but are actually just vascular malformations. The diagnosis and treatment for aggressive VHs is still controversial, due to their rarity.PurposeTo evaluate the safety and efficiency of the present diagnostic methods and treatment choices.Study designA retrospective study of aggressive VHs with neurologic deficit.Patients sampleA total of 29 consecutive aggressive VH cases were diagnosed and treated in our department since 2001.Outcome measuresWe routinely took anteroposterior and lateral spinal roentgenograms, computed tomography, and magnetic resonance images.MethodsTrocar biopsy is indicated in suspected malignant cases. Radiotherapy was usually our first choice if the neurologic deficit was mild or developed slowly. Surgery was indicated if the neurologic deficit was severe or developed quickly or if the radiotherapy was not effective.ResultsThis series included 12 males and 17 females, and the mean age at diagnosis was 44.0 years (range, 21–72 years). Ten patients had radiculopathy, 1 had cauda equina syndrome, and 18 cases had myelopathy. Twenty-one cases had lesions in the thoracic spine, 5 in the lumbar, and 3 in the cervical region. Eleven cases had untypical image findings, including five cases with pathologic vertebral fracture. The neurologic compression came from only epidural soft tumor mass in 18 cases, whereas it came from both bony compression and soft lesion in the other 11 cases. Ten cases had radiotherapy alone, but two failed and had surgery later. Twenty-one cases had surgery. In the 12 cases having surgical decompression without vertebroplasty, the average estimated blood loss was 1900 mL, and it was 1093 mL for the eight cases having decompression with vertebroplasty. The average follow-up was 51.1 months (range, 24–133 months). There was no recurrence in those cases with radiotherapy, whereas three had local recurrence in those six cases treated by surgical decompression alone without radiotherapy.ConclusionsIn aggressive VHs, epidural soft-tissue compression was usually the main reason for neurologic deficit. In cases with rapid progressive and/or severe myelopathy, posterior decompression and stabilization could be combined with intraoperative vertebroplasty to reduce blood loss.     

The potential role of heat shock proteins in acute spinal cord injury

Purpose

This study aims to investigate the differential expression proteins profile of spinal cord tissues after acute spinal cord injury (ASCI), provide preliminary results for further study and explore the secondary injury mechanisms underlying ASCI.

Methods

Using Allen’s frame to establish ASCI model of Sprague–Dawley rats, then a stable isotope-labelled strategy using isobaric tags for relative and absolute quantitation (iTRAQ) coupled with two-dimensional (2D) liquid chromatography tandem mass spectrometry (2D LC–MS/MS) was performed to separate and identify differentially expressed proteins.

Results

A total of 220 differentially expressed proteins were identified in the spinal cord tissues of H-8 group (acute spinal cord injury after 8 h) compared with H-0 group (acute spinal cord injury after 0 h); Up to 116 proteins were up-regulated, whereas 104 proteins were down-regulated in the spinal cord tissues. Three of the differentially expressed Heat shock proteins (HSPs) namely, Hsp90ab1, Hspa4 and Hspe1 were down-regulated.

Conclusion

The differentially expressed proteins of spinal cord tissues after ASCI will provide scientific foundation for further study to explore the secondary injury mechanism of ASCI.     

蛇床子素与金雀异黄酮对大鼠峰值骨量影响的比较研究

研究蛇床子素（Osthole,OST）与金雀异黄酮（Genistein,GEN）对大鼠峰值骨密度与骨质量的影响。方法：采用随机分组法将36只1月龄SD雌性大鼠（125±3）g分为3组：对照组（CON,等体积蒸馏水,n=12）,蛇床子素组（OST,9mg·kg^-1d^-1i．g．,n=12）,金雀异黄酮组（GEN,10mg·kg^-1d^-1i．g．;n=12）。每周监测体重,每月用双能x射线骨密度仪（DEXA）检测全身骨密度。3个月后处死所有动物,采用酶联免疫法测定血清骨钙素（Osteocalcin,0C）和抗酒石酸性磷酸酶5b（Tartaficacid phosphatase 5b,TRACP 5b）含量,用DEXA测定股骨骨密度,用μCT分析股骨组织微结构,树脂包埋不脱钙骨组织切片技术做胫骨骨形态分析,用万能材料试验机测定股骨生物力学,称量心、肝、胃、肾、肾上腺和子宫湿重,计算器官指数,并做常规病理学检测。结果：大鼠的体重、器官指数差异无统计学意义（P〉0．05）;病理学观察未见异常发生;第1、2个月全身骨密度无明显差异（P〉0．05）,第3个月后OST组全身骨密度显著高于CON组、GEN组,上述3组中股骨骨密度与全身骨密度的变化呈相同趋势（P〈0．05）。与对照组相比,OST组、GEN组血清OC水平升高,而与CON组、GEN组相比,0ST组的TRACP5b含量下降（P〈0．05）;OST组的骨体积百分率、骨小梁厚度和骨小梁数量均高于CON组,但骨小梁分离度和模型系数均显著低于CON组（P〈0．05）,OST组与GEN组的上述指标虽未出现统计学差异（P〉0．05）,但平均值OST组高于GEN组;OST组骨小梁厚度和骨小梁数量均高于CON组、GEN组,但骨小梁分离度低于CON组、GEN组;OST组股骨最大载荷、弹性模量和屈服强度均明显高于CON组（P〈0．05）,OST组与GEN组虽未出现统计学差异（P〉0．05）,但平均值OST组高于GEN组。结论：口服蛇床子素能有效提高大鼠峰值骨量,从而?     

颈椎人工椎间盘置换术后患者负性心理的改善及其对预后的影响

目的 观察颈椎病患者行颈椎人工椎间盘置换术后负性心理的改善情况,探讨颈椎病患者抑郁、焦虑等负性心理发生的危险因素及其对预后的影响.方法 回顾性分析2010年1月-2012年1月于本院行颈椎椎间盘置换术的85例患者术前术后抑郁、焦虑心理状况.于术前及术后1周、3个月、6个月、1年及末次随访时采用Zung抑郁自评量表（self-rating depression scale,SDS）和Zung焦虑自评量表（self-rating anxiety scale,SAS）评估患者负性心理,颈部及上肢疼痛视觉模拟量表（visual analogue scale,VAS）评分、日本骨科学会（Japan Orthopedic Association,JOA）评分评估神经功能,SF-36量表评估生活质量,以单因素相关分析对结果进行统计处理.结果 所有患者临床症状和神经功能改善满意.12例（14.12%）患者术前出现明显的抑郁,21例（24.70%）患者出现焦虑;术后1周患者SDS和SAS评分均较术前改善,焦虑改善程度有统计学意义,抑郁改善程度无统计学意义.末次随访时患者抑郁和焦虑评分与VAS和SF-36评分显著相关,但与年龄和JOA评分无显著相关.结论 部分颈椎病患者术前存在抑郁及焦虑,颈椎人工椎间盘置换术可以部分改善这2种心理,患者负性心理对其预后具有负性作用.     

Should We Routinely Transfuse Platelet for Immune Thrombocytopenia Patients with Platelet Count Less Than 10 × 109/L Who Underwent Laparoscopic Splenectomy?

Background

Laparoscopic splenectomy (LS) is considered as the gold standard procedure for patients with immune thrombocytopenia (ITP). In many institutions, platelet counts less than 10 × 10⁹/L contraindicate LS.

Objective

This study aimed to investigate the safety and feasibility of LS for ITP patients with platelet counts less than 10 × 10⁹/L.

Methods

A total of 88 cases of LS were performed for ITP patients from June 2010 to December 2012. The patients were prospectively divided into three groups based on their immediate preoperative platelet count: < 10 × 10⁹/L (group 1); 10 × 10⁹/L to 30 × 10⁹/L (group 2); and > 30 × 10⁹/L (group 3). We collected the patients’ demographic characteristics, perioperative details, and platelet count response to surgery.

Results

The patients in the three groups had comparable demographic characteristics. Only one patient in group 1 required conversion (2.4 %). The patients in group 1 experienced more blood loss than those in group 3, but this was not statistically significant. There were no significant differences between group 2 and group 3 in terms of operating time and blood loss. No statistically significant differences were found between the three groups with regard to complications and postoperative hospital stay.

Conclusions

It is safe and feasible to perform LS in ITP patients with platelet count less than 10 × 10⁹/L, without platelet transfusion. The indication for platelet transfusion during LS for ITP patients should be the bleeding manifestations due to thrombocytopenia other than low platelet count itself.     

Effects of low intensity vibration on bone and muscle in rats with spinal cord injury

Summary

Spinal cord injury (SCI) causes rapid and marked bone loss. The present study demonstrates that low-intensity vibration (LIV) improves selected biomarkers of bone turnover and gene expression and reduces osteoclastogenesis, suggesting that LIV may be expected to benefit to bone mass, resorption, and formation after SCI.

Introduction

Sublesional bone is rapidly and extensively lost following spinal cord injury (SCI). Low-intensity vibration (LIV) has been suggested to reduce loss of bone in children with disabilities and osteoporotic women, but its efficacy in SCI-related bone loss has not been tested. The purpose of this study was to characterize effects of LIV on bone and bone cells in an animal model of SCI.

Methods

The effects of LIV initiated 28 days after SCI and provided for 15 min twice daily 5 days each week for 35 days were examined in female rats with moderate severity contusion injury of the mid-thoracic spinal cord.

Results

Bone mineral density (BMD) of the distal femur and proximal tibia declined by 5 % and was not altered by LIV. Serum osteocalcin was reduced after SCI by 20 % and was increased by LIV to a level similar to that of control animals. The osteoclastogenic potential of bone marrow precursors was increased after SCI by twofold and associated with 30 % elevation in serum CTX. LIV reduced the osteoclastogenic potential of marrow precursors by 70 % but did not alter serum CTX. LIV completely reversed the twofold elevation in messenger RNA (mRNA) levels for SOST and the 40 % reduction in Runx2 mRNA in bone marrow stromal cells resulting from SCI.

Conclusion

The findings demonstrate an ability of LIV to improve selected biomarkers of bone turnover and gene expression and to reduce osteoclastogenesis. The study indicates a possibility that LIV initiated earlier after SCI and/or continued for a longer duration would increase bone mass.     

超声实时组织弹性成像诊断颈动脉易损斑块

目的探讨超声实时组织弹性成像(RTE)技术对颈动脉易损斑块的诊断价值。方法选取缺血性脑血管病患者60例,对颈动脉斑块进行超声弹性成像;采用Itoh 5分法对斑块RTE图像进行评分,并与颈动脉内膜切除术(CEA)术后病理学检查进行对照分析。结果超声弹性图彩色编码显示斑块脂质坏死核心为绿色,纤维为蓝色,钙化为蓝白色,出血/血栓为绿色、红绿色相间、蓝绿色相间。60例中,纤维斑块12例,粥样斑块24例,斑块内出血/血栓9例,复杂斑块15例。弹性成像诊断易损斑块的敏感度、特异度、准确率分别为93.75%(45/48)、83.33%(10/12)、91.67%(55/60),阳性预测值、阴性预测值分别为95.74%(45/47)、76.92%(10/13),阳性似然比、阴性似然比分别为5.62、0.075。结论超声弹性成像技术对颈动脉易损斑块有较好的诊断价值。     

Current status of bone graft options for anterior interbody fusion of the cervical and lumbar spine

Anterior cervical discectomy and fusion (ACDF) and anterior lumbar interbody fusion (ALIF) are common surgical procedures for degenerative disc disease of the cervical and lumbar spine. Over the years, many bone graft options have been developed and investigated aimed at complimenting or substituting autograft bone, the traditional fusion substrate. Here, we summarise the historical context, biological basis and current best evidence for these bone graft options in ACDF and ALIF.