The relevance of long head biceps degeneration in the presence of rotator cuff tears

Background  

Long head biceps (LHB) degeneration in combination with rotator cuff tears can be a source of chronic shoulder pain. LHB tenotomy is an approved surgical procedure for pain reduction and improvement of joint function, however, the pathophysiology of LHB degeneration is not fully understood. In the literature, neoangiogenesis in tendon tissue has previously been shown to be associated with tendon degeneration. Vascular Endothelial Growth Factor (VEGF) is an important inducer of neoangiogenesis. The hypotheses are first that an elevated VEGF expression and vessel density can be found in degenerated LHB tissue and second that there is a relation between VEGF expression, vessel density and the different types of rotator cuff tears.     

Salmonella enterica serovar Typhimurium adhesion and cytotoxicity during epithelial cell stress is reduced by Lactobacillus rhamnosus GG

Background

Physiological stressors may alter susceptibility of the host intestinal epithelium to infection by enteric pathogens. In the current study, cytotoxic effect, adhesion and invasion of Salmonella enterica serovar Typhimurium (S. Typhimurium) to Caco-2 cells exposed to thermal stress (41°C, 1 h) was investigated. Probiotic bacteria have been shown to reduce interaction of pathogens with the epithelium under non-stress conditions and may have a significant effect on epithelial viability during infection; however, probiotic effect on pathogen interaction with epithelial cells under physiological stress is not known. Therefore, we investigated the influence of Lactobacillus rhamnosus GG and Lactobacillus gasseri on Salmonella adhesion and Salmonella-induced cytotoxicity of Caco-2 cells subjected to thermal stress.

Results

Thermal stress increased the cytotoxic effect of both S. Typhimurium (P = 0.0001) and nonpathogenic E. coli K12 (P = 0.004) to Caco-2 cells, and resulted in greater susceptibility of cell monolayers to S. Typhimurium adhesion (P = 0.001). Thermal stress had no significant impact on inflammatory cytokines released by Caco-2 cells, although exposure to S. Typhimurium resulted in greater than 80% increase in production of IL-6 and IL-8. Blocking S. Typhimurium with anti-ShdA antibody prior to exposure of Salmonella decreased adhesion (P = 0.01) to non-stressed and thermal-stressed Caco-2 cells. Pre-exposure of Caco-2 cells to L. rhamnosus GG significantly reduced Salmonella-induced cytotoxicity (P = 0.001) and Salmonella adhesion (P = 0.001) to Caco-2 cells during thermal stress, while L. gasseri had no effect.

Conclusion

Results suggest that thermal stress increases susceptibility of intestinal epithelial Caco-2 cells to Salmonella adhesion, and increases the cytotoxic effect of Salmonella during infection. Use of L. rhamnosus GG as a probiotic may reduce the severity of infection during epithelial cell stress. Mechanisms by which thermal stress increases susceptibility to S. Typhimurium colonization and by which L. rhamnosus GG limits the severity of infection remain to be elucidated.     

Identification of a novel susceptibility locus for juvenile idiopathic arthritis by genome‐wide association analysis

Objective

Juvenile idiopathic arthritis (JIA) is a chronic rheumatic disease of childhood. Two well‐established genetic factors known to contribute to JIA susceptibility, HLA and PTPN22, account for less than half of the genetic susceptibility to disease; therefore, additional genetic factors have yet to be identified. The purpose of this study was to perform a systematic search of the genome to identify novel susceptibility loci for JIA.

Methods

A genome‐wide association study using Affymetrix GeneChip 100K arrays was performed in a discovery cohort (279 cases and 184 controls). Single‐nucleotide polymorphisms (SNPs) showing the most significant differences between cases and controls were then genotyped in a validation sample of cases (n = 321) and controls, combined with control data from the 1958 UK birth cohort (n = 2,024). In one region in which association was confirmed, fine‐mapping was performed (654 cases and 1,847 controls).

Results

Of the 112 SNPs that were significantly associated with JIA in the discovery cohort, 6 SNPs were associated with JIA in the independent validation cohort. The most strongly associated SNP mapped to the HLA region, while the second strongest association was with a SNP within the VTCN1 gene. Fine‐mapping of that gene was performed, and 10 SNPs were found to be associated with JIA.

Conclusion

This study is the first to successfully apply a SNP‐based genome‐wide association approach to the investigation of JIA. The replicated association with markers in the VTCN1 gene defined an additional susceptibility locus for JIA and implicates a novel pathway in the pathogenesis of this chronic disease of childhood.

     

建立卒中医疗体系的建议美国卒中协会特别工作组关于建立卒中体系的建议

在美国,卒中一直是残疾和死亡的重要原因。每年约有70万例美国人新发或复发卒中,在与其他心血管病分开评价时,卒中在美国仍是第三位死亡原因。在美国卒中还是严重和长期残疾的第一位原因[1]。在过去几十年里,卒中的预防、治疗和康复已取得重大进展。尽管在实施新的有效治疗方法方面取得了一些成功,但在确保将这些科学进展转化为临床实践的过程中仍然存在很大障碍。在很多情况下,这些障碍与卒中相关医疗分散有关,后者是在提供卒中治疗过程中原本应密切协作的各种设施、机构和医疗专业人员整合不够充分所致。人们日益强调对卒中医疗各个组成部…     

The time of diagnosis impacts surgical management but not the outcome of patients with gallbladder Carcinoma

Background

Only 50% of gallbladder cancers (GBC) are recognized before operation and the remaining tumors are diagnosed during surgery or afterwards by the pathologist. These situations may demand substantial modifications of the proceeding during surgery as well as the need for reoperation in some cases. Therefore, the time of diagnosis may strongly influence the surgical management of GBC and the prognosis of the patients.

Methods

Records and follow-up of 152 patients with gallbladder carcinoma who underwent surgery between 1980 and 2004 were examined according to the time of diagnosis, TNM staging system, surgical procedures, morbidity and predictors of survival. There were 76 patients with preoperative diagnosis of GBC (50%; group1), 44 patients with intraoperative diagnosis (29%; group 2) and 32 patients (21%; group 3) with postoperatively incidental finding of GBC. In all cases radical resection of the GBC was intended, except in 5 patients from group 1. Surgical procedures comprised from simple cholecystectomy to multivisceral resections.

Results

Overall 5-year survival rate was 7% with a significantly better median survival in group 3 (53.2 month), when compared to only 6.1 month (group 2) and 5.4 month (group 1), respectively. Findings at operation forced significant modifications of the surgical strategy in 85%. Complete resection of GBC was achieved in 38% of the patients. Stage- dependent survival was comparable between the groups following R0 resection. Tumor stage, in particular the nodal status and radicality of the procedure, but not the time of diagnosis were the most powerful predictors of outcome.

Conclusions

Complete tumor resection may provide long-term survival even in locally advanced GBC. Although the time of diagnosis of GBC causes significant changes of the intended procedures during and after surgery, it has no influence on the prognosis provided that radical (R0) resection was accomplished.     

Quality of routine spirometry tests in Dutch general practices

Background

Spirometry is an indispensable tool for diagnosis and monitoring of chronic airways disease in primary care.

Aim

To establish the quality of routine spirometry tests in general practice, and explore associations between test quality and patient characteristics.

Design of study

Analysis of routine spirometry test records.

Setting

Fifteen general practices which had a working agreement with a local hospital pulmonary function laboratory for spirometry assessment regarding test quality and interpretation.

Method

Spirometry tests were judged by a pulmonary function technician and a chest physician. Proportions of test adequacy were analysed using markers for manoeuvre acceptability and test reproducibility derived from the 1994 American Thoracic Society spirometry guideline. Associations between quality markers and age, sex, and severity of obstruction were examined using logistic regression.

Results

Practices performed a mean of four (standard deviation = 2) spirometry tests per week; 1271 tests from 1091 adult patients were analysed; 96.4% (95% confidence interval [CI] = 95.6 to 97.2) of all tests consisted of ≥3 blows. With 60.6% of tests, forced expiratory time was the marker with the lowest acceptability rate. An overall 38.8% (95% CI = 36.0 to 41.6) of the tests met the acceptability as well as reproducibility criteria. Age, sex, and severity of obstruction were associated with test quality markers.

Conclusion

The quality of routine spirometry tests was better than in previous reports from primary care research settings, but there is still substantial room for improvement. Sufficient duration of forced expiratory time is the quality marker with the highest rate of inadequacy. Primary care professionals should be aware of patient characteristics that may diminish the quality of their spirometry tests. Further research is needed to establish to what extent spirometry tests that are inadequate, according to stringent international expert criteria, result in incorrect clinical interpretations in general practice.