Hepatitis B vaccination in human immunodeficiency virus-infected adults receiving hemodialysis

BACKGROUND: The Centers for Disease Control and Prevention (CDC) recommends hepatitis B virus (HBV) immunization for all hemodialysis (HD) patients because they are at high risk of infection. Several studies have shown that the development of protective antibody titers after HBV vaccination is much lower in HD patients. We hypothesized that human immunodeficiency virus (HIV) infection in patients with end-stage renal disease (ESRD) would further impair the immune response to hepatitis B vaccination. METHODS: We performed a retrospective cohort study of patients undergoing long-term hemodialysis from 1990 to 2002 at the United States-based dialysis facilities of Gambro Corporation, North America. The response rate defined as an increase in anti-HBs levels >/=10 mIU/L after a month of the third dose of HBV vaccination was determined in HIV-infected and a randomly selected group of ESRD patients. The demographic information, laboratory data, and hepatitis B surface antibody (anti-HBs) titers were recorded from the Gambro Corporation database on these patients. RESULTS: Of the 347 adult HIV ESRD patients, 116 received three doses of recombinant hepatitis B vaccination. Seventy percent were male, and the majority (86%) were black. Of the 116 patients who received three doses of HBV vaccination, 62 (53.4%) developed protective antibody titers. This was comparable to the response rate of 50.4% in the randomly selected 220 non-HIV hemodialysis patients. Among HIV ESRD patients, the mean hemoglobin (Hgb) was higher in patients who developed protective antibody titers (Hgb 11.61 +/- 2 vs. 10.55 +/- 1.86, P value <0.01). On multivariate logistic regression analysis, higher Hgb was associated with protective antibody titers (odds ratio: 1.34, 95% CI 0.99-1.72). Seventy percent of the HIV-infected responders maintained protective antibody titers 6 months after vaccination. CONCLUSION: Hepatitis B vaccination should be offered to all HIV-infected ESRD patients because over half of the patients with HIV and ESRD can develop protective antibodies.     

Treatment for axillary osmidrosis with suction-assisted cartilage shaver.

Axillary osmidrosis is a common and distressing social problem for many. Topical astringents are temporary and inadequate. Permanent solutions often involve invasive surgical treatment. This study is to evaluate the effectiveness and advantages of treating axillary osmidrosis with suction-assisted cartilage shaver. Eighty-nine patients with osmidrosis were treated with suction-assisted cartilage shaver under local anesthesia on an outpatient basis. Patients were followed-up and surveyed for satisfaction with surgery by completing a questionnaire. Of the 89 patients, 82 patients (92.1%) expressed positive satisfaction with the procedure. In the elimination of odour, a total of 81 patients (91.0%) ranked good to excellent, and seven patients (7.9%) expressed fair results. All of the 89 patients (100%) detected the clearing of wound induration within 3 months. Eighty patients (89.9%) felt their arms were back in full range of movement within 1 month, and all had such hindrance resolved within 2 months. Thus, the procedure proved itself a promising treatment for the removal of sweat glands with advantages of a short operation time, inconspicuous scar, and a rapid recovery for returning to daily activities.     

Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve

BACKGROUND: The aim of this study was to assess the risk of recurrent laryngeal nerve palsy (RLNP) after thyroidectomy with routine identification of the recurrent laryngeal nerve (RLN) during the operation. METHODS: The present study was confined to 521 patients, 348 total lobectomies and 178 total thyroidectomies, treated by the same surgeon. Temporary and permanent RLNP rates were analyzed for patient groups with stratification of primary operation for benign thyroid disease, thyroid cancer, Graves' disease, and reoperation. Measurement of the RLNP rate was based on the number of nerves at risk. Twenty-six RLNs in 20 thyroid cancer patients with intentional sacrifice were excluded from analysis. RESULTS: Forty RLNs (40 patients) developed postoperative RLNP. Complete recovery of RLN function was documented for 35 of the 37 patients (94.6%) whose RLN integrity had been ensured intraoperatively. Recovery from temporary RLNP ranged from 3 days to 4 months (mean, 30.7 days). Overall incidence of temporary and permanent RLNP was 5.1% and 0.9%, respectively. The rates of temporary/permanent RLNP were 4.0/0.2%, 2.0/0.7%, 12.0/1.1%, and 10.8/8.1% for groups classified according to benign thyroid disease, thyroid cancer, Graves' disease, and reoperation, respectively. CONCLUSIONS: Operations for thyroid cancer, Graves' disease, and recurrent goiter demonstrated significantly higher RLNP rates. Invasion of RLN was identified in 19.4% of patients with thyroid cancer. Postoperatively, the RLN recovered in most of the patients without documented nerve damage during the operation. Total lobectomy with routine RLN identification is recommended as a basic procedure in thyroid operations.     

Risk factors of early complications after thoracic and lumbar spinal deformity surgery: a systematic review and meta-analysis

European Spine Journal - To determine risk factors increasing susceptibility to early complications (intraoperative and postoperative within 6&nbsp;weeks) associated with surgery to correct...     

Oral and dental manifestations in diabetic and nondiabetic uremic patients receiving hemodialysis.

OBJECTIVE: The aim of this study was to examine the dental condition and oral manifestations in diabetic and nondiabetic uremic patients undergoing hemodialysis. STUDY DESIGN: A total of 128 patients undergoing hemodialysis therapy were classified into the diabetic and nondiabetic groups and examined for uremic oral manifestations, dental caries, and the periodontal status. All the patients received predialytic salivary pH examination. In the diabetic group, the correlation between oral findings and glycemic controlled levels, which was collected based on Hb A1C values, were further studied. RESULTS: The diabetic group exhibited significantly higher prevalence of caries and more severe dry mouth, taste change, and mucosa pain than the nondiabetic group. The diabetic group tended to have lower predialytic salivary pH, and patients with poor glycemic control (ie, Hb A1C > 9%) showed higher incidence of dry mouth, mucosal pain, and tongue coating. However, the DMFT and CPI index were not associated with glycemic control in the diabetic group. CONCLUSIONS: This study reveals that diabetic uremic patients undergoing maintained hemodialysis exhibited a potentially higher risk for dental decay and xerostomia. Lower salivary pH and poor glycemic control may affect oral manifestations. Further research is needed to clarify the combined influence of diabetic nephropathy on oral health.     

TomoDirect技术在全脑全脊髓放疗中的应用

目的 为全脑全脊髓放疗建立新的TomoDirect技术(TD)布野方案,并评价剂量学参数。方法 对本院收治的7例全脑全脊髓放疗患者进行回顾性研究,在Tomo计划系统分别设计5野TD、3野TD和螺旋断层治疗(helical tomotherapy, HT)计划,比较3种计划的靶区适形指数(CI)、均匀性指数(HI)、危及器官受量、治疗时间和机器跳数(MU)。结果 除3野TD计划外其余两者均能获得较好的靶区适形度和均匀性。其中5野TD计划靶区受量明显优于3野TD计划,但略逊于HT计划;危及器官受量则各有优势。5野TD、3野TD和HT计划的靶区平均CI分别为0.79、0.57和0.88;靶区HI分别为1.06、1.16和1.05;双肺V₂₀分别为1.99%、3.30%和2.16%;心脏平均剂量分别为6.17、12.38和10.72 Gy;肝脏平均剂量分别为5.21、5.14和4.62 Gy;左侧肾脏平均剂量分别为4.30、1.99和5.03 Gy;右侧肾脏平均剂量分别为4.42、2.09和4.91 Gy。靶区以外的正常组织V₅分别为46.80%、28.06%和55.54%。5野TD计划的治疗时间最短,5野TD、3野TD及HT计划的平均治疗时间分别为677、721和907 s,MU数分别是8 773、9 657和12 581。结论 5野的TD技术应用于全脑全脊髓放疗具有一定优势,适用于难以坚持长时间治疗,且希望减少低剂量范围的患者。     

Extracorporeal shock wave treatment modulates skin fibroblast recruitment and leukocyte infiltration for enhancing extended skin-flap survival

Extracorporeal shock wave (ESW) treatment has a positive effect of rescuing ischemic skin flaps. This study assessed whether ESW treatment rescues the compromised flap tissue by suppressing the apoptosis of ischemic tissue and recruiting tissue remodeling. We used a random-pattern extended dorsal–skin-flap (10 × 3 cm) rodent model. Thirty-six male Sprague–Dawley rats were divided into three groups. Group I, the control group, received no treatment. Group II received one session of ESW treatment (500 impulses at 0.15 mJ/mm²) immediately after surgery. Group III received two sessions of ESW treatment, immediately and the day after the surgery. Results indicated that the necrotic area in the flaps in group II was significantly smaller than that of the flaps in group I ( p <0.01). Transferase dUTP-nick end labeling (TUNEL) analysis revealed a significant decrease in the number of apoptotic cells in group II. Hydrogen peroxide (H₂O₂) expression in circulation blood was significantly decreased in group II on the day after ESW treatment. Immunohistochemical staining indicated that compared with no treatment, ESW treatment could substantially increase proliferating cell nuclear antigen (PCNA), endothelial nitric oxide synthase, and prolyl 4-hydroxylase (rPH) expression, reduce CD45 expression, and suppress 8-hydroxyguanosine (8-OG) expression in the ischemic zone of the flap tissue. In conclusion, ESW treatment administered at an optimal dosage exerts a positive effect of rescuing ischemic extended skin flaps. The mechanisms of action of ESWs involve modulation of oxygen radicals, attenuation of leukocyte infiltration, decrease in tissue apoptosis, and recruitment of skin fibroblasts, which results in increased flap tissue survival.     

Novel quinolone CHM‐1 induces apoptosis and inhibits metastasis in a human osterogenic sarcoma cell line

Novel 2‐phenyl‐4‐quinolone compounds have potent cytotoxic effects on different human cancer cell lines. In this study, we examined anticancer activity and mechanisms of 20‐fluoro‐6,7‐methylenedioxy‐2‐phenyl‐4‐quinolone (CHM‐1) in human osterogenic sarcoma U‐2 OS cells. CHM‐1‐induced apoptosis was determined by flow cytometric analysis, DAPI staining, Comet assay, and caspase inhibitors. CHM‐1‐inhibited cell migration and invasion was assessed by a wound healing assay, gelatin zymography, and a Transwell assay. The mechanisms of CHM‐1 effects on apoptosis and metastasis signaling pathways were studied using Western blotting and gene expression. CHM‐1 induced G2/M arrest and apoptosis at an IC₅₀ (3 µM) in U‐2 OS cells and caspase‐3, ‐8, and ‐9 were activated. Caspase inhibitors increased cell viability after exposure to CHM‐1. CHM‐1‐induced apoptosis was associated with enhanced ROS generation, DNA damage, decreased ΔΨ_m levels, and promotion of mitochondrial cytochrome c release. CHM‐1 stimulated mRNA expression of caspase‐3, ‐8, and ‐9, AIF, and Endo G. In addition, CHM‐1 inhibited cell metastasis at a low concentration (<3 µM). CHM‐1 inhibited the cell metastasis through the inhibition of MMP‐2, ‐7, and ‐9. CHM‐1 also decreased the levels of MAPK signaling pathways before leading to the inhibition of MMPs. In summary, CHM‐1 is a potent inducer of apoptosis, which plays a role in the anticancer activity of CHM‐1. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:1637–1644, 2009     

Nonparallel cutaneous microcirculatory responses to pharmacologic alterations of systemic arterial pressure in rats

Both hypotension and hypertension aggravate the damage of reperfusion injury after reconstructive microsurgery. The purpose of this study is to establish a theoretical guide for postoperative blood pressure control in optimizing the cutaneous perfusion and flap survival. Systemic arterial pressure was altered by the intravenous infusion of saline, sodium nitroprusside, phentolamine, and phenylephrine in thirty‐two 280–350 g anesthetized Sprague Dawley rats. Power spectral analysis of systemic arterial pressure (SAP) and laser Doppler flowmetry (flux) of epigastric skin were used to reveal the blood pressure and cutaneous blood flow variabilities. Nonparallel responses of cutaneous perfusion and blood pressure were found. The baseline SAP and flux were 126.0 ± 1.4 mmHg and 57.2 ± 1.8 au, respectively. Sodium nitroprusside and phentolamine significantly decreased the SAP (71.1 ± 2.7 and 70.5 ± 1.5 mmHg, P < 0.0001). However, the corresponding responses in cutaneous perfusion were opposite (56.2 ± 3.1 au, P = 0.7389 and 36.2 ± 2.3 au, P < 0.0001). Phenylephrine significantly increased the SAP (171.7 ± 3.0 mmHg, P < 0.0001) but the flux of epigastric skin was decreased (44.4 ± 2.6 au, P < 0.0001). Phentolamine and phenylephrine showed negative effects on the systemic cardiac and vascular sympathetic modulations. Sodium nitroprusside had a trend in increasing systemic vasomotor activity. We suggested not using vasoconstrictors in treating intra and postoperative hypotension associated with free flap transfer. Nitric oxide donors are superior to α‐adrenoceptor antagonists in preserving the cutaneous flap perfusion when treating postoperative hypertension. © 2009 Wiley‐Liss, Inc. Microsurgery, 2009.