Influence of Physical Activity on Bone Strength in Children and Adolescents: A Systematic Review and Narrative Synthesis

A preponderance of evidence from systematic reviews supports the effectiveness of weight‐bearing exercises on bone mass accrual, especially during the growing years. However, only one systematic review (limited to randomized controlled trials) examined the role of physical activity (PA) on bone strength. Thus, our systematic review extended the scope of the previous review by including all PA intervention and observational studies, including organized sports participation studies, with child or adolescent bone strength as the main outcome. We also sought to discern the skeletal elements (eg, mass, structure, density) that accompanied significant bone strength changes. Our electronic‐database, forward, and reference searches yielded 14 intervention and 23 observational studies that met our inclusion criteria. We used the Effective Public Health Practice Project (EPHPP) tool to assess the quality of studies. Due to heterogeneity across studies, we adopted a narrative synthesis for our analysis and found that bone strength adaptations to PA were related to maturity level, sex, and study quality. Three (of five) weight‐bearing PA intervention studies with a strong rating reported significantly greater gains in bone strength for the intervention group (3% to 4%) compared with only three significant (of nine) moderate intervention studies. Changes in bone structure (eg, bone cross‐sectional area, cortical thickness, alone or in combination) rather than bone mass most often accompanied significant bone strength outcomes. Prepuberty and peripuberty may be the most opportune time for boys and girls to enhance bone strength through PA, although this finding is tempered by the few available studies in more mature groups. Despite the central role that muscle plays in bones' response to loading, few studies discerned the specific contribution of muscle function (or surrogates) to bone strength. Although not the focus of the current review, this seems an important consideration for future studies. © 2014 American Society for Bone and Mineral Research.     

肝泡型包虫病临床分期与sIL-2R、TNF-α和IFN-γ含量的关系

为探讨肝泡型包虫病（Alveolar echinococcosis AE)临床分期与sIL-2R,TNF-α和IFN－γ含量的关系和意义,将经B超和血清学方法证实的23例AE病人和对照组12人采血后,用ELISA双抗体夹心法,做sIL-2R,TNF-α和IFN－γ含量的测定。按B超肝脏扫描的声像损害情况,将AE分期（组）,对照相应细胞因子的含量,经方差分析和Q检验,讨论细胞因子在AE发育增殖中的可能作用和临床意义。结果P2组、P3组、P4组和对照组sIL-2R每mL含量均值分别为96.57u、226.44u、193.81u、110.89u;TNF－α含量均值分别为P2组1．12μg/L,P3组3＝67μg/L,P4组1．30μg/L,对照组则为0．40μg/L;IFN－γ含量均值分别为P2组360ng/L,P3组486ng/L,P4组259ng/L,对照组则为15.63ng/L;各组经方差分析和Q检验,证实AE病人病理的三个不同时期,其sIL-2R,TNF-α和IFN－γ的含量均有显著性差异（P＜0．01）。sIL-2R含量均值除P2与对照组无差异外（P＞0．05）,其余各组与P2组和对照组均有显著性差异（P＜0．05）;TNF－α含量在P3组最高（P＜0．01）;AE各组病人的IFN－γ含量明显高于对照组（P＜0．01）,而AE病人组间却并无差异（P＞0．05）。低水平的sIL-2R可视为AE早期病变或疾病稳定的指标;反之则表示属AE的进展期;高水平的TNF－α可能是造成AE肝组织损伤的因素之一;单一的IFN－γ对AE的免疫防御作用有限,并不能有效地阻止AE的病理进展。     

全球195个国家18亿青少年健康调查:慢病占青少年疾病负担一半以上,是青年人健康状况每况愈下的主因

正一项针对全球195个国家的18亿10-24岁的青少年健康状况的调查研究显示,这些年轻人正面临比25年前更大的健康挑战。文章称,目前的10～24岁的人口是有史以来最多的,截至2016年达到18亿,印度和中国拥有全球三分之一的青少年(6.22亿)。印度青少年人口增长了40%,然而,中国青少年人口从1990年的3.52亿减少到2016年的2.53亿。2016年青少年的DALYs为2.53亿,非传染性疾病(NCD)占青少年疾病负担的56%(1.42亿),NCD是所有国家青年人健康状况每况愈下的主要     

Antiphospholipid antibodies and venous thromboembolism

The clinical relevance of antiphospholipid antibodies (APLA) in patients without systemic lupus erythematosus who have venous thromboembolism (VTE) in unknown. Limited evidence suggests that there is an association between the presence of APLA and both initial and recurrent episodes of VTE and that patients with APLA and VTE are resistant to warfarin therapy. Unselected patients with a first episode of clinically suspected deep vein thrombosis or pulmonary embolism were evaluated with objective tests for VTE and with laboratory tests for APLA; the latter included tests for the lupus anticoagulant (LA) and anticardiolipin antibodies (ACLA). Patients with VTE were treated with anticoagulant therapy and observed during and after discontinuation of anticoagulants for symptomatic recurrence of VTE. There was a strong association between LA and VTE (odds ratio, 9.4; 95% confidence interval [CI], 2.1 to 46.2) and 9 to 65 (14%; 95% CI, 7% to 25%) patients with VTE had LA. There was no association between the presence of ACLA and VTE (odds ratio, 0.7; 95%CI, 0.3 to 1.7) because of the high frequency of positive ACLA assays in patients without VTE. None of the 16 patients with VTE and APLA developed recurrent VTE while receiving warfarin therapy. There was no difference in rates of recurrent VTE in patients with or without APLA after anticoagulant therapy was discontinued. The strong association between LA and VTE suggests that testing for LA in patients with VTE is useful. The measurement of ACLA in patients with VTE has no clinical usefulness because the results are abnormal in a high proportion of patients without VTE. Although the presence of APLA in patients with VTE was not associated with resistance to a conventional intensity of warfarin or an increased risk of recurrent VTE after discontinuation of warfarin, a larger study should address these issues in a subgroup of patients with VTE and LA.     

Anti‐inflammatory effects of exendin‐4, a glucagon‐like peptide‐1 analog,on human peripheral lymphocytes in patients with type 2 diabetes

Aims/Introduction

Type 2 diabetes is characterized by dysregulation of immunity, oxidative stress and reduced incretin effects. Experimental studies suggest that glucagon‐like peptide (GLP‐1) might have immunomodulating effects. We hypothesize that GLP‐1 receptor agonist, exendin‐4, might reduce inflammatory response in type 2 diabetes.

Materials and Methods

Using peripheral blood mononuclear cells (PBMC) sampled from 10 type 2 diabetes and 10 sex‐ and age‐matched control subjects and supernatants from PBMC culture, the expression of phospho‐mitogen activated protein kinase (MAPK) signaling pathways in CD4+ T helper lymphocytes and monocytes was analyzed using flow cytometry. Cytokines/chemokines and superoxide anion before and after treatment with exendin‐4 were measured by cytometric bead array and chemiluminesence assay, respectively.

Results

Compared with control subjects, PBMC from type 2 diabetes patients showed activated MAPK (P38, c‐Jun NH2‐terminal protein kinase and extracellular signal‐regulated kinase) signaling pathway, elevated superoxide anion, increased pro‐inflammatory cytokines (tumor necrosis factor‐α, interleukin‐1β, interleukin‐6) and chemokines (CCL5/regulated on activation normal T‐cell expressed and secreted and CXCL10/interferon‐γ‐induced protein 10). These changes were attenuated by exendin‐4, possibly through the suppression of p38 MAPK.

Conclusions

These results suggest that exendin‐4 might downregulate pro‐inflammatory responses and reduce oxidative stress by suppressing MAPK signaling pathways in type 2 diabetes.     

Awareness of eye complications and prevalence of retinopathy in the first visit to eye clinic among type 2 diabetic patients

AIM: To assess the awareness of eye complications and the prevalence of retinopathy, in the first visit to eye clinic, among type 2 diabetic patients attending a tertiary medical centre in Kuala Lumpur, Malaysia. METHODS: An investigator-administered questionnaire was given to 137 patients with diabetes undergoing first time eye screening in the eye clinic. This was followed by a detailed fundus examination by a senior ophthalmologist to assess for presence of retinopathy. RESULTS: Almost 86% of respondents were aware of diabetic eye complications, especially in patients who had achieved tertiary educational level (96.3%). The majority of the patients (78.8%) were referred by their physicians and only 20.4% came on their own initiative. Many of the patients (43.8%) did not know how frequent they should go for an eye check-up and 72.3% did not know what treatments were available. Lack of understanding on diabetic eye diseases (68.6%) was the main barrier for most patients for not coming for eye screening earlier. Despite a high level of awareness, only 21.9% had recorded HbA1c level of <6.5% while 31.4% were under the erroneous assumption of having a good blood sugar control. A total of 29.2% had diabetic retinopathy in their first visit eye testing. CONCLUSION: In the present study, 29.2% of type 2 diabetic patients had retinopathy in their first time eye testing. Although the awareness of diabetic eye complications was high among first time eye screening patients, the appropriate eye care-seeking behavior was comparatively less and should be rectified to prevent the rise of this sight threatening eye disease.     

青蒿琥酯经皮肤吸收治疗猴疟的疗效

青蒿琥酯为高效、速效、低毒的抗疟新药,但近期复燃率较高。为了提高疗效,方便使用,乃研究其经皮肤吸收制剂。青蒿琥酯经皮肤吸收对鼠疟的疗效,在小鼠及兔体内的药代动力学研究已取得较好的结果,现报告对猴疟的疗效。