Magnetic resonance imaging of the knee after medial unicompartmental arthroplasty

Objective

We evaluated safety and potential diagnostic value of magnetic resonance (MR) imaging of the knee treated with medial unicompartmental arthroplasty (MUA).

Methods

The treated knee of 8 patients who underwent MUA was studied with four different 1.5-T MR sequences. Two radiologists independently evaluated eleven anatomical items using a score from 0 (not assessable) to 3 (completely assessable). The sum of the scores for each sequence was divided by the potential maximal sum, obtaining a percentage visibility index (PVI) for each item.

Results

No adverse effect was reported during or within 30 min after the exam. Posterior cruciate ligament was unseen in all patients by both observers. The following PVIs were reported for the remaining ten items: femoral–patellar relationship 83–100%; femoral–patellar cartilage 92–100%; Hoffa's fat pad 75–92%; patellar ligament 79–100%; lateral meniscus 100%; femoral–tibial lateral joint 100%; lateral collateral ligament 96–100%; anterior cruciate ligament 54–83%; femoral–tibial lateral cartilages 92–100%; posterolateral corner 100%. Agreement between readers was found in 331/352 (94%) evaluations (k = 0.74–0.78).

Conclusions

MR imaging after MUA offers a safe and reproducible evaluation of residual knee anatomy except for cruciate ligament, and can be used to follow-up these patients.     

Novel soy germ pasta improves endothelial function, blood pressure, and oxidative stress in patients with type 2 diabetes

OBJECTIVE

To compare the effects of a novel soy germ–enriched pasta, containing isoflavone aglycons, with conventional pasta on endothelial function and cardiovascular risk markers in patients with type 2 diabetes (T2D).

RESEARCH DESIGN AND METHODS

This randomized controlled double-blind crossover study compared one serving/day of soy germ pasta and conventional pasta for 8 weeks for effects on brachial artery flow-mediated vasodilation, blood pressure, plasma lipids, oxidized LDL cholesterol, 8-iso-PGF2α, total antioxidant capacity (TAC), glutathione (GSH), and homocysteine.

RESULTS

Isoflavone-enriched pasta significantly improved arterial stiffness (P = 0.005) and reduced systolic (P = 0.026) and diastolic (P = 0.017) blood pressures. Plasma TAC increased (P = 0.0002), oxidized LDL cholesterol decreased (P = 0.009), 8-iso-PGF2α decreased (P = 0.001), GSH levels increased (P = 0.0003), and homocysteine decreased (P = 0.009) consistent with a reduction in oxidative stress. No significant changes were observed with conventional pasta.

CONCLUSIONS

Pasta enriched with biologically active isoflavone aglycons improved endothelial function and had beneficial effects on cardiovascular risk markers in patients with T2D.The risk of cardiovascular disease and stroke is 3–4 times greater in patients with type 2 diabetes (T2D) than in the general population (1). It results from loss of normal endothelial function and is associated with increased oxidative stress, production of reactive oxygen species (2), and a decrease in antioxidative defense systems (3). Hypertension, dyslipidemia, and hyperhomocysteinemia also contribute to overall morbidity and mortality. In a recent study of patients with hypercholesterolemia, a soy germ–enriched pasta containing isoflavones, in mainly the biologically active aglycon form, significantly improved serum lipids and other markers of cardiovascular risk, including arterial reactivity, beyond that of an American Heart Association Step II diet alone (4). Our objective was to determine whether similar effects from this novel food could be attained in patients with T2D.     

Cataract surgery and diabetic retinopathy

Diabetes is a risk factor for the development of cataracts. Studies have shown an increased risk of ocular complications in diabetics after cataract surgery, but modern surgical techniques have minimized them, leading to an overall good visual outcome. Macular edema before surgery is the most common condition that limits post-operative visual recovery. Thus, pre-operative laser treatment is needed. Photocoagulation of preproliferative or early proliferative diabetic retinopathy is also advisable, due to the increased risk of iris neovascularization or retinopathy progression after surgery.     

Proton pump inhibitor treatment of patients with gastroesophageal reflux-related chronic cough： A comparison between two different daily doses of lansoprazole

AIM:To compare two different daily doses oflansoprazole given for 12 weeks and to assess the roleof gastrointestinal (GI) investigations as criteria forselecting patients.METHODS:Out of 45 patients referred for unexplainedchronic persistent cough,36 had at least one of theGI investigations (endoscopy,24-h esophageal pH-metry and a 4-week trial of proton pump inhibitor (PPI)therapy) positive and were randomly assigned to receiveeither 30 mg lansoprazole o.d.or 30 mg lansoprazoleb.i.d,for 12 weeks.Symptoms were evaluated atbaseline (visit 1) after the PPI test (visit 2) and after the12-week lansoprazole treatment period (visit 3).RESULTS:Thirty-five patients completed the studyprotocol.Twenty-one patients (60.0%) reportedcomplete relief from their cough with no differencebetween the two treatment groups (58.8% and 61.1%had no cough in 30 mg lansoprazole and 60 mglansoprazole groups,respectively).More than 80% ofthe patients who had complete relief from their cough atthe end of the treatment showed a positive response tothe PPI test.CONCLUSION:Twelve weeks of lansoprazole treatmenteven at a standard daily dose,is effective in patientswith chronic persistent cough.A positive response to aninitial PPI test seems to be the best criterion for selectingpatients who respond to therapy.     

Clinical experience with gefitinib: an update

Gefitinib is an orally active, selective epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) that blocks signal transduction pathways involved in cell proliferation. This drug demonstrated impressive and durable responses in patients with heavily pretreated non-small cell lung cancer (NSCLC). In two large phase II trials, responses were observed in 9-19% of unselected patients, along with symptom improvement and benefit in quality of life. Biological mechanisms underlying TKI sensitivity have recently been discovered. There is evidence that specific EGFR gene mutations and/or amplification confer a particularly sensitive phenotype, especially in individuals with tumors demonstrating activation of the anti-apoptotic protein Akt. However, in all so far conducted clinical trials, no patient selection has been made, providing a logical explanation for the negative results observed in large phase III studies. In the present review, we will summarize the results observed in clinical trials with gefitinib. We will present results obtained in NSCLC and in other solid tumor, focusing on biological and clinical markers predicting drug sensitivity.