Immunotoxicity activity of natural furocoumarins from milky sap of Ficus carica L. against Aedes aegypti L

Ficus carica L., its fruits are delicious and can be eaten by human. Its leaves are commonly used to cure hemorrhoid and clear away heart ache. The milky sap of F. carica have a significant toxic effect against early fourth-stage larvae of Aedes aegypti L with an lethal concentration (LC(50)) value of 10.2?μg/ml and an LC(90) value of 42.3?μg/ml. Two natural furocoumarins, 5-methoxypsoralen and 8-methoxypsoralen were isolated from the milky sap of F. carica. The LC(50) value of 5-methoxypsoralen and 8-methoxypsoralen were 9.4 and 56.3?μg/ml, respectively. The above indicates that major compounds may play a more important role in the toxicity of the milky sap of F. carica.     

Relationships of Fetal-Type Erythropoiesis versus Nitric Oxide Production and Glycated Hemoglobin Levels in Diabetics

This study investigated the potential contribution of nitric oxide (NOx) production to enhanced fetal hemoglobin (HbF) synthesis in patients with diabetes. Glycated hemoglobin (HbA1c), HbF, high sensitivity C-reactive protein (hsCRP), plasma glucose levels, and serum NOx concentrations were measured in 350 diabetics and 125 healthy subjects. There were no significant correlations between HbF and HbA1c levels, nor between HbF and plasma glucose levels. However, serum NOx concentrations in patients with HbF >1.0% (76.2 ± 32.4 μmol/L) were significantly higher than those with HbF ≤ 1.0% (47.3 ± 29.8 μmol/L, p <0.05). Inversely, patients with moderately increased serum NOx levels >98.1 μmol/L (75th percentile of patients) exhibited significantly higher HbF levels than those with decreased serum NOx levels <34.2 μmol/L (25th percentile of patients) (1.16 ± 0.41 vs. 0.62 ± 0.28%, p <0.05). After excluding the subjects with high NOx levels, elevated HbF concentrations returned to a level not significantly different from the control value. Serum NOx concentrations were significantly correlated with HbF (r = 0.32, p <0.05) and hsCRP levels (r = 0.35, p <0.05) in diabetic patients. In conclusion, long-term glycemic control does not contribute to fetal-type erythropoiesis, but increased NOx production seems to play an important role in the enhanced HbF synthesis of diabetics.     

Treatment of Periprosthetic Hip Infection Caused by Resistant Microorganisms Using 2-Stage Reimplantation Protocol

To determine the effectiveness of staged reimplantation for the treatment of periprosthetic hip infection caused by resistant microorganisms, we performed a retrospective case-control study on 37 consecutive patients who had a culture-proven periprosthetic hip infection treated using a 2-stage reimplantation protocol. Twenty-four patients infected by resistant microorganisms were compared with 13 patients infected by nonresistant microorganisms. The second-stage reimplantation procedure was possible in 34 (92%) of the 37 patients, but the remaining 3 required permanent resection because of persistent infection. At a mean follow-up of 4.4 years, there were 4 recurrent infections and 1 aseptic cup loosening. Overall treatment failure rate was 22%. All failures occurred only in the resistant microorganism group and none in the nonresistant microorganism group (33% vs 0%; P = .032). Current 2-stage reimplantation protocol showed a high rate of treatment failure in our patients with a periprosthetic hip infection caused by resistant microorganisms.     

Biomechanical rigidity of an all-polyetheretherketone anterior thoracolumbar spinal reconstruction construct: an in vitro corpectomy model

Background contextPolyetheretherketone (PEEK) is gaining favor as a spinal implant material for interbody and corpectomy cages as well as stabilizing rods. However, there has been little correlation to a relevant and reproducible clinical model. Biomechanical data on PEEK rod constructs have not been reported.PurposeTo quantify the stabilizing effects of PEEK versus titanium (Ti) instrumentation in a thoracolumbar corpectomy model.Study designCorpectomy and randomized instrumentation with an all-Ti, all-PEEK, and hybrid cage/rod construct were performed on cadaveric spines to assess biomechanical differences.MethodsPure unconstrained bending moments were applied to the intact spine and subsequent test constructs in the three physiologic planes using a load control protocol. Motion tracking and analysis were carried out to quantify and compare the range of motion (ROM) between different test constructs in each plane.ResultsFlexion ROM did not show significant changes compared with intact, whereas the all-Ti and hybrid construct reduced ROM significantly in extension. Lateral bending was significantly reduced in all the treatment groups. Rotational stability of the construct was significantly compromised by an all-PEEK spinal construct.ConclusionThe rigidity of the corpectomy construct increased as the amount of Ti in the construct increased. A hybrid construct incorporating a PEEK corpectomy cage and Ti rods may provide adequate stability for an anterior thoracolumbar reconstruction in the sagittal and coronal planes. An all-PEEK construct may provide adequate stability in the coronal and sagittal planes but may compromise the stability significantly in axial rotation. Consideration should be given for supplemental posterior instrumentation if an all-PEEK construct is used in an anterior thoracolumbar spinal reconstruction procedure.     

Factors for conversion in laparoscopic cholecystectomy for acute cholecystitis: Is timing important?

Aim: Laparoscopic cholecystectomy is regarded as the gold standard treatment for gallstones. Conversion to open cholecystectomy is still common, and preoperative factors to predict conversion are useful in clinical practice. The aim of this study was to evaluate preoperative factors that could predict conversion in acute cholecystitis. Methods: This is a retrospective review of 83 patients with a diagnosis of acute cholecystitis who had laparoscopic cholecystectomy carried out as an emergency operation. Clinical, biochemical, and operative factors were analyzed for association with conversion. Results: A total of 83 patients were recruited to this study. The overall conversion rate was 33.7% (28/83). A longer duration of symptoms before presentation (P = 0.005) and surgery that was carried out over 48 h after admission (P = 0.022) were associated with a higher conversion rate. Emergency operations that began between 20.00 hours and 08.00 hours were also associated with a higher rate of conversion (P = 0.003). Other factors that were associated with conversion included male sex (P = 0.004), low albumin level upon admission (P = 0.024), prolonged prothrombin time (P = 0.040), and a raised serum total bilirubin level (P = 0.024). ASA scores were found to be similar in both groups (P = 0.509). Multivariate analysis by logistic regression showed that the independent risk factors for conversion in emergency laparoscopic cholecystectomy were surgery >48 h after admission (P = 0.028), emergency operation started between 20.00 hours and 08.00 hours (P = 0.026), and longer duration of symptoms before presentation (P = 0.034). Conclusions: Laparoscopic cholecystectomy should be carried out within 48 h of the patient being admitted for acute cholecystitis. The operation should be carried out during the daytime.     

Lateral Calcaneal Artery Adipofascial Flap for Reconstruction of the Posterior Heel of the Foot

Background

Soft tissue defects of the posterior heel of the foot present difficult reconstructive problems. This paper reports the authors'' early experience of five patients treated with a lateral calcaneal artery adipofascial flap.

Methods

Between 2003 and 2007, five patients (3 males and 2 females) with soft-tissue defects over the posterior heel underwent a reconstruction using a lateral calcaneal artery adipofascial flap and a full-thickness skin graft. The flap sizes ranged from 3.5 × 2.5 cm to 5.5 × 4.0 cm.

Results

All five flaps survived completely with no subsequent breakdown of the grafted skin, even after regularly wearing normal shoes. The adipofascial flap donor sites were closed primarily in all patients.

Conclusions

Lateral calcaneal artery adipofascial flaps should be included in the surgical armamentarium to cover difficult wounds of the posterior heel of the foot. These flaps do not require the sacrifice of a major artery to the leg or foot, they are relatively thin with minimal morbidity at the donor site, and leave a simple linear scar over the lateral aspect of the foot.