A case of interleukin-12 receptor beta-1 deficiency with recurrent leishmaniasis

Interleukin-12 receptor beta-1 (IL-12Rbeta1) defect is generally associated with selective susceptibility to weakly pathogenic mycobacteria and Salmonella species. Patients rarely experience infections caused by other organisms. We report a 5-year-old patient with IL-12Rbeta1 deficiency who developed recurrent visceral leishmaniasis 6 months apart. The patient responded to lyposomal amphotericin B treatment reasonably well.     

下颌第一磨牙牙合向受力时整体下颌骨应力有限元分析

目的:采用有限元方法分析正常下颌第一磨牙咬合面受力时,下颌骨局部及整体应力变化,为种植牙对的影响提供理论依据。方法:CT扫描1例正常成年人下颌骨,Mimics14.11软件建立下颌骨模型,下颌第一磨牙面给予100 N的垂直力,有限元分析软件ABAQUS6.9-3分析整个下颌骨应力的变化。结果:下颌第一磨牙垂直受力时,下颌第一磨牙周围骨质应力应变最大处为底部偏向颊侧;整个下颌骨受力分析中,应力应变主要集中在受力的下颌第一磨牙处,其次在对侧下颌角位置,应力应变沿着下颌骨外斜线传导至髁突,显示了髁突部分应力应变的变化。结论:采用有限元方法,分析下颌第一磨牙正常咬合力时下颌骨应力应变变化,为下颌第一磨牙种植修复提供生物力学依据,以便获得最佳临床修复效果。     

Short Insulin Tolerance Test Can Determine the Effects of Thiazolidinediones Treatment in Type 2 Diabetes

Purpose

The short insulin tolerance test is a simple and reliable method of estimating insulin sensitivity. This study was designed to compare the insulin sensitizing effects of thiazolidinediones (TZDs) on the degree of insulin resistance, determined by a short insulin tolerance test (Kitt) in type 2 diabetic patients.

Patients and Methods

Eighty-three subjects (mean age = 57.87 ± 10.78) with type 2 diabetes mellitus were enrolled and received daily one dose of rosiglitazone (4 mg) or pioglitazone (15 mg). The mean follow-up duration was 25.39 ± 9.66 months. We assessed insulin sensitivity using HOMA-IR and the short insulin tolerance test before and after TZDs treatment.

Results

When we compared patients'' characteristics before and after TZDs treatment, the mean fasting glucose level was significantly decreased (183.27 ± 55.04 to 137.35 ± 36.42 mg/dL, p < 0.001) and the mean HbA1C level was significantly decreased (9.24 ± 1.96 to 8.11 ± 1.39%, p < 0.001). Also, Kitt values were significantly increased (2.03 ± 1.14 to 2.67 ± 0.97%/min, p = 0.003), whereas HOMA-IR was significantly decreased (2.98 ± 0.68 to 1.04 ± 0.24, p < 0.05). When classifying insulin resistance by Kitt values, insulin resistant subjects'' values were increased (< 2.5 %/min; 1.51 ± 0.53%/min to 2.63 ± 0.88, p < 0.001), whereas the values decreased in insulin sensitive subjects (≥ 2.5%/min; 3.50 ± 0.75%/min to 2.75 ± 1.12%/min, p = 0.002).

Conclusion

The glucose lowering effects of TZDs by improving insulin resistance could be determined by using Kitt. However, Kitt may be a beneficial tool to determine TZDs'' effects only when patients'' Kitt values are less than 2.5%/min.     

Macrolide resistance trends in beta-hemolytic streptococci in a tertiary Korean hospital

PURPOSE: Erythromycin-resistant beta-hemolytic streptococci (BHS) has recently emerged and quickly spread between and within countries throughout the world. In this study, we evaluate the antimicrobial susceptibility patterns and erythromycin resistance mechanisms of BHS during 2003-2004. MATERIALS AND METHODS: The MICs of seven antimicrobials were determined for 204 clinical isolates of BHS from 2003 to 2004. Resistance mechanisms of erythromycin-resistant BHS were studied by the double disk test as well as by polymerase chain reaction (PCR). RESULTS: Compared with our previous study, resistance among Streptococcus pyogenes isolates to a variety of drugs decreased strikingly: from 25.7% to 4.8% in erythromycin; 15.8% to 0% in clindamycin; and 47.1% to 19.0% in tetracycline. The prevalent phenotypes and genotypes of macrolide-lincosamide-streptograminB (MLSB) resistance in Streptococcus pyogenes isolates have been changed from the constitutive MLSB phenotype carrying erm(B) to the M phenotype with mef(A) gene. In contrast with Streptococcus pyogenes, resistance rates to erythromycin (36.7%), clindamycin (43.1%), and tetracycline (95.4%) in Streptococcus agalactiae isolates did not show decreasing trends. Among the Streptococcus dysgalactiae subsp. equisimilis isolates (Lancefield group C, G), resistance rates to erythromycin, clindamycin, tetracycline and chloramphenicol were observed to be 9.4%, 3.1%, 68.8%, and 9.4%, respectively. Conclusion: Continual monitoring of antimicrobial resistance among large-colony-forming BHS is needed to provide the medical community with current data regarding the resistance mechanisms that are most common to their local or regional environments.     

Antimicrobial susceptibility patterns and macrolide resistance genes of beta-hemolytic viridans group streptococci in a tertiary Korean hospital

The aim of this study was to investigate antimicrobial susceptibilities and macrolide resistance mechanisms of beta-hemolytic viridans group streptococci (VGS) in a tertiary Korean hospital. Minimum inhibitory concentrations (MICs) of seven antimicrobials were determined for 103 beta-hemolytic VGS isolated from various specimens. The macrolide resistance mechanisms of erythromycin-resistant isolates were studied by the double disk test and polymerase chain reaction (PCR). The overall resistance rates of beta-hemolytic VGS were found to be 47.5% to tetracycline, 3.9% to chloramphenicol, 9.7% to erythromycin, and 6.8% to clindamycin, whereas all isolates were susceptible to penicillin G, ceftriaxone, and vancomycin. Among ten erythromycin-resistant isolates, six isolates expressed a constitutive MLS(B) (cMLS(B)) phenotype, and each of the two isolates expressed the M phenotype, and the inducible MLS(B) (iMLS(B)) phenotype. The resistance rates to erythromycin and clindamycin of beta-hemolytic VGS seemed to be lower than those of non-beta-hemolytic VGS in our hospital, although cMLSB phenotype carrying erm(B) was dominant in beta-hemolytic VGS.     

The pain associated with intraarticular hyaluronic acid injections for trapeziometacarpal osteoarthritis

Trapeziometacarpal osteoarthritis predominantly affects middle-aged women. Most cases with rhizarthrosis can be managed successfully by conservative means. The purpose of this prospective study was to evaluate pain and tolerability of viscosupplementation therapy with hyaluronic acid (HA) for trapeziometacarpal osteoarthritis. Groups A and B consisted of eight patients each with Eaton stage 3 or 4 rhizarthrosis, who underwent one cycle of three injections of (one per week) 0.3 cm³ sodium hyaluronate. The injections for group A were under fluoroscopy control, but fluoroscopy was not used in group B. Pain and tolerability of both groups A and B were measured and compared. The patients of the groups were also asked to evaluate the tolerability of the treatment. The results suggested that HA injection in the carpometacarpal joint is a tolerable procedure but the patients complained of pain and discomfort during the injections. The pain in group A was much greater than in group B. Viscosupplementation for the treatment of trapeziometacarpal osteoarthritis is a viable treatment option for stages 3 and 4 patients when they do not want to be operated on. It is a tolerable but not a painless procedure especially when it is done without fluoroscopy control. We recommend giving injections under fluoroscopy control.     

Osteomusculocutaneous flap for clavicular reconstruction: a case report

Radiotherapy for tumors can cause soft tissue necrosis, osteonecrosis, and pathologic fractures. A 47-year-old woman presented with a pathologic fracture of the left clavicle 10 years after radiotherapy following radical mastectomy for breast cancer. She was treated with a compound rib-latissimus dorsi osteomusculocutaneous flap with a 4-cm segment of the sixth rib. Fusion of the bones was achieved in three months. Donor site morbidity was cosmetically acceptable and function of the shoulder was improved. The Constant shoulder score which was 36 preoperatively increased to 88 after 38 months of follow-up.     

Evaluation of Growth Hormone Results in Different Diagnosis and Trend Over 10 Year of Follow-up: A Single Center Experience

Objective:The aim was to evaluate the results of diagnosis, follow-up and treatment of the patients who recieved growth hormone (GH) treatment for the last 10 years and to determine the differences in the process and results over the years.Methods:Anthropometric, clinical, laboratory data, treatment adherence and side effects were evaluated retrospectively in 767 patients who recieved GH treatment between 2009-2018. Patients were grouped as isolated GH deficiency (IGHD), multiple pituitary hormone deficiency (MPHD), small for gestational age (SGA), and Turner syndrome (TS) depending on diagnosis.Results:GH treatment was started in 689 cases (89.8%) with IGHD, 24 (3.1%) with MPHD, 26 (3.4%) with SGA and 28 (3.7%) with TS. Median age of GH treatment onset was the earliest in SGA (8.4 years) and the latest in the IGHD group (12.0 years). At the time of treatment cessation, height standard deviation score (SDS) in IGHD and MPHD was significantly higher than treatment initiation time, whereas there was no significant difference in TS and SGA. One hundred eighty-nine cases reached the final height. Final heights for girls/boys were: IGHD 154/164.9 cm; MPHD 156.2/163.5 cm; TS 146.7 cm; and SGA 145.7/-cm, respectively. Target height SDS-final height SDS median values were IGHD: 0.1, MPHD: 0.6, SGA: 0.5, TS: 2.4 respectively. The patients’ treatment compliance was high (92%) and the incidence of side effects was low (2.7%).Conclusion:In our cohort, GH treatment start age was late and no difference in this was observed in the last 10 years. The improvement in the height SDS was most marked in the IGHD and MPHD groups, the least in the TS and SGA groups.     

Differential sensitivity of naïve and subsets of memory CD4+ and CD8+ T cells to hydrogen peroxide-induced apoptosis

CD4+ and CD8+ memory T cells are identified into central and effector memory subsets, which are characterized by distinct homing patterns and functions. In this investigation, we show that na?ve and central memory CD4+ and CD8+ T cells are sensitive to hydrogen peroxide (H2O2)-induced apoptosis, whereas effector memory CD4+ and CD8+ T cells are relatively resistant to H2O2-induced apoptosis. Apoptosis in na?ve and central memory CD4+ and CD8+ is associated with the release of cytochrome c and activation of caspase-9 and caspase-3, upregulation of Bax and voltage-dependent anion channel (VDAC) expression, and decreased intracellular glutathione (GSH). In vitro GSH and a superoxide dismutase mimetic Mn(III) tetrakis (1-methyl-4-pyridyl) porphyrin inhibited H2O2-induced apoptosis in both na?ve and central memory CD4+ and CD8+ T cells. Furthermore, VDAC inhibitor 4,4'-diisothiocynostilbene-2,2'-disulfonic acid blocked H2O2-induced apoptosis. These data demonstrate that H2O2 induces apoptosis preferentially in human na?ve and central memory CD4+ and CD8+ T cells via the mitochondrial pathway by regulating intracellular GSH and the expression of Bax and VDAC.     

Halothane hepatotoxicity and hepatic free radical metabolism in guinea pigs; the effects of vitamin E

Purpose

The aim of this study was to investigate the relation between halothane hepatotoxicity and hepatic free radical metabolism and to establish a possible protective role of vitamin E against halothane hepatotoxicity.

Methods

Twenty-eight guinea pigs were used in the experiments. Halothane (1.5% v/v) in oxygen (100%) was given to the animals for 90 min over three days. Livers from animals were then taken and prepared for the assays. In the enzymatic study, Superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) activities were measured. As a peroxidation index, the malondialdehyde (MDA) concentration was determined. Also, electron spin resonance (ESR) analysis and electron microscopy (EM) were performed. Results: Superoxide dismutase (1168.3 ± 78.2 U · mg^?1) and glutathione peroxidase (14.9 ± 6.2 mIU · mg^?1) activities were decreased, but catalase activity (1260.0 ± 250.6 lU · mg^?1) and malondialdehyde concentration (11.5 ± 1.8 ppb) were increased in liver tissues exposed to halothane compared with control values (1382.2 ± 91.8 U · mg^?1 for SOD, 27.8 ± 5.2 mIU · mg^?1 for GSH-Px, 840.2 ± 252.4 IU · mg^?1 for CAT and 10.0 ± 1.0 ppb for MDA). Electron spin resonance analysis revealed a peak of CF₃ CHCl radical in the exposed tissue. Electron microscopy indicated ultrastructural changes in the hepatic cells of both halothane groups with and without vitamin E treatment.

Conclusion

Halothane causes impairment in the hepatic antioxidant defense system and accelerates peroxidation reactions. As a result, some ultrastructural changes in hepatic tissues occur due to halothane treatment. Although vitamin E prevents peroxidative damage, it does not ameliorate ultrastructural changes caused by halothane treatment. This shows that halothane toxicity results not only from impaired hepatic antioxidant defense system but also from other, unknown causes.