A new heparin fragment decreases liver ischemia-reperfusion injury

<正>To the Editor:Ischemia-reperfusion injury following surgery and transplantation can lead to irreversible multiorgan failure.Intracellular calcium overload is associated to cellular death during ischemiareperfusion.A recently discovered heparin fragment (HF),trisulfated disaccharide (TD),that acts on sodium-calcium exchanger(NCX) decreasing intracellular Ca²⁺,showed effectiveness on protecting hepatocytes from ischemia-reperfusion injury [1],     

The Impact of Pharmacy Students’ Remediation Status on NAPLEX First-Time Pass Rates

Objective. To determine whether there is a difference in pass rates on the North American Pharmacist Licensure Examination (NAPLEX) between students who did and did not require remediation for deficient course grades.Methods. Student-specific data were collected regarding course grade deficiencies and completion of a comprehensive examination or course for remediation. Student-specific first-time NAPLEX performance data for the graduating classes of 2008, 2009, and 2011were provided by the National Association of Boards of Pharmacy (NABP).Results. A significant difference was found in first-time NAPLEX mean pass rates between students who did not need to undergo remediation versus those who did ( 97% vs 70%).Conclusion. Students requiring remediation for deficient course grades had a lower pass rate on the NAPLEX compared with those who did not require remediation. The difference can be attributed to several factors and therefore further study is needed.     

Myocardial K kinetics in rats on Mg-deficient diet.

Kinetics and distribution of K were studied in myocardiuum of chronic Mg-deficient rats. The experimental design was as follows. Rats were fed either Mg-deficient or control diet for 30 days. They were then injected with 0.2 mCi of K-43. One half hour after injection they were killed and a segment of myocardium was washed with nonradioactive Krebs solution in a special chamber. Radioactivity remaining in the tissue was recorded continuously for 1 hour. A three-compartment model (extracellular, main intracellular, and subcellular) was used; transport rate constants (kij) and relative compartment sizes (qj) were determined. In myocardium of Mg-deficient rats the kij's and q's indicated greatly reduced intracellular accumulation of K but a large accumulation of K within the subcellular compartment probably mitochondrial. There was also some enlargement of the extracellular compartment. The extracellular to overall intracellular ratio for K increased 46% in Mg-deficient myocardium. The hypothesis that dietary Mg deficiency affects Na-K pump function is discussed.     

Use of monoclonal antibodies to identify cerebrospinal fluid lymphoblasts in children with acute lymphoblastic leukemia

The identification of small numbers of leukemic cells in the cerebrospinal fluid (CSF) presents a diagnostic problem in the treatment of children with acute lymphoblastic leukemia (ALL). We adapted a latex sphere rosetting technique to allow us to identify simultaneously cell surface markers and cell morphology in 199 CSF samples from 34 patients and 14 control subjects. In patients without leukemic meningitis, the majority of CSF lymphocytes (69%) were found to be mature T cells positive for OKT11. A much smaller number of cells (8%) were found to be B cells positive for la. In these children, only 3% of CSF lymphoid cells expressed the common acute lymphoblastic leukemia antigen (CALLA). Similar results were found in the control subjects. By contrast, 28 CSF samples from nine children with varying numbers of CSF lymphoblasts had much greater proportions of CALLA- and la-positive CSF cells (24% to 96%). Leukemic meningitis was present in one of these patients and later developed in four others. However, three patients with small numbers of lymphoblasts present but with low proportions of CALLA-positive CSF cells (less than 5%) subsequently had normal CSF examinations. We found the use of this rosetting technique valuable in providing information complementary to that obtained from cell morphology alone about the possible malignant nature of small numbers of lymphoblast-like CSF cells seen on cytocentrifuge preparations in children with ALL.     

High versus low glycemic index 3-h recovery diets following glycogen-depleting exercise has no effect on subsequent 5-km cycling time trial performance

ObjectivesSome athletes train/compete multiple times in a single day and rapid restoration of muscle and hepatic glycogen stores is therefore important for athletic performance.DesignRandomised, counterbalanced, crossover, single blinded study investigated the effects of low/high glycaemic index (GI) meals on the physiological responses to a 3-h recovery period and subsequent 5-km cycling time trial (TT).MethodsSeven male cyclists completed glycogen-depleting exercise followed by a 3-h recovery period, when participants consumed either a high or low GI meal providing 2 g kg^?1 BM of carbohydrate. Participants then performed a 5-km cycling TT. Blood samples were analysed for glucose insulin, free fatty acid (FFA) and triglyceride.ResultsThere was no significant difference between the median (IQR) cycling TT time of 8.5 (3.0) min in the LGI condition and 8.4 (1.8) min in the HGI condition (p = 0.45). Serum insulin was significantly higher in the HGI condition throughout the 3-h recovery period (p = 0.025), FFA concentrations were higher in the HGI condition only at 30 min into recovery (p = 0.008). The respiratory exchange ratio (p = 0.028) and carbohydrate oxidation rate (p = 0.015) increased over time in the HGI condition, whereas the rate of fat oxidation demonstrated the opposite response (p = 0.001). No significant differences between conditions were observed for any physiological variables at the end of the 5-km TT.ConclusionsAlthough the GI of the two meals indicated important metabolic differences during the recovery period, there was no evidence suggesting these differences influenced subsequent 5-km TT performance.     

A prospective randomized trial comparing image quality,study interpretability,and radiation dose of narrow acquisition window with widened acquisition window protocols in prospectively ECG-triggered coronary computed tomography angiography

BackgroundProspectively triggered coronary computed tomography angiography (CTA) is commonly performed with a widened acquisition window to provide flexibility in image reconstruction.ObjectiveWe conducted a randomized controlled trial to determine whether the use of a narrow acquisition window in prospectively triggered coronary CTA would allow lower radiation dose while preserving image quality and interpretability.MethodsProspective 2-center 2- platform randomized trial that evaluated 205 consecutive patients 96 with widened acquisition (WA) and 109 narrow acquisition (NA) referred for coronary CTA in sinus rhythm and heart rate <65 beats/min. Patients scanned with WA had phases reconstructed at 5% intervals, and each phase was assigned an individual study ID. Images were reviewed with individual phase reconstructions interpreted randomly by 2 level 3 readers with a third for consensus. Images were evaluated with a 5-point Likert scale on a per-vessel basis (best score on any phase). Scores were then dichotomized into diagnostic (score 3–5) compared with nondiagnostic (score 1–2). Readers also reported obstructive coronary artery disease on a per-patient basis. Agreement for the diagnosis of obstructive disease and per-artery interpretability was performed. Signal and noise measurements were also performed.ResultsNo difference in demographics between groups (P = NS). The signal-to-noise ratio was comparable 12.99 ± 3.4 NA and 12.53 ± 4.13 for the WA (P = 0.45). The median effective dose was 1.78 mSv for NA compared with 3.26 mSv for WA (P < 0.001). Image quality, diagnostic interpretability, interreader agreement, and downstream testing were not significantly different between the 2 groups (P= NS for all).ConclusionsCoronary CTA with NA resulted in a 47% lower radiation dose without significant difference in study interpretability or image quality or increased downstream resource use or testing.     

Tip to apex distance in femoral intertrochanteric fractures: a systematic review

Background

Hip fractures are associated with high morbidity, mortality, and cost. Implants used for hip fracture fixation can fail for many reasons including lag screw cut-out. Tip–apex distance (TAD) is indicative of the position and depth of a screw in the femoral head and has been shown to be associated with cut-out failure. We conducted a systematic review of the published literature to quantify the association between TAD and cut-out failure for patients undergoing hip fracture fixation surgery.

Methods

We performed a search of the Medline, Embase, and Cochrane databases. We performed abstract and full text reviews independently and in duplicate. We used a random effects model to combine, in duplicate, the incidence of cut-out for patients who had TAD <25 mm and TAD >25 mm. We also combined mean TAD values for patients who had cut-out failure and those who did not.

Results

Seventeen studies were eligible for this review, four of which were included in combined analysis of dichotomous outcomes and seven in combined analysis of continuous outcomes. Patients with TAD >25 mm had a significantly greater risk of cut-out than patients with TAD <25 mm (RR = 12.71). Patients who experienced implant cut-out had significantly higher TAD scores than those who did not (mean difference = 6.54 mm).

Conclusion

Tip–apex distance is an important concept in relation to cut-out failure of hip fracture fixation surgery. Surgeons should understand and apply the concept of TAD to improve outcomes for their patients.     

EAU Guidelines on Assessment and Nonsurgical Management of Urinary Incontinence

Context

The previous European Association of Urology (EAU) guidelines on urinary incontinence comprised a summary of sections of the 2009 International Consultation on Incontinence. A decision was made in 2010 to rewrite these guidelines based on an independent systematic review carried out by the EAU guidelines panel, using a sustainable methodology.

Objective

We present a short version of the full guidelines on assessment, diagnosis, and nonsurgical treatment of urinary incontinence, with the aim of increasing their dissemination.

Evidence acquisition

Evidence appraisal included a pragmatic review of existing systematic reviews and independent new literature searches, based on Population, Intervention, Comparator, Outcome questions. Appraisal of papers was carried out by an international panel of experts, who also collaborated on a series of consensus discussions, to develop concise structured evidence summaries and action-based recommendations using a modified Oxford system.

Evidence summary

The full version of the guidelines is available online (http://www.uroweb.org/guidelines/online-guidelines/). The guidelines include algorithms that refer the reader back to the supporting evidence, and they are more immediately useable in daily clinical practice.

Conclusions

These new guidelines present an up-to-date summary of the available evidence, together with clear clinical algorithms and action-based recommendations based on the best available evidence. Where such evidence does not exist, they present a consensus of expert opinion.     

Ventral hernia repair: a study of current practice

Ventral wall hernias are common; despite this, there are no guidelines on the best surgical management. The aim of this study was to examine the types of repair in use for abdominal wall hernias in the West of Scotland over a 3-month period. Data were gathered on 120 patients. There were 60 incisional, 32 umbilical, and 28 epigastric hernias. The main indication for repair was pain (78%), while 12 patients (10%), presented acutely with incarceration or strangulation. The most common method of repair was sutured (55%), followed by mesh (29%) and Mayo repair (16%). There was no correlation between use of mesh and hernia size or whether repair was for a recurrent hernia. Surgical practice varies widely in the repair of ventral wall hernias. Clinical trials are required to establish the best method of repair for this common condition. Electronic Publication