The efficacy of physiotherapy upon shoulder function following axillary dissection in breast cancer,a randomized controlled study

Background  

Many patients suffer from severe shoulder complaints after breast cancer surgery and axillary lymph node dissection. Physiotherapy has been clinically observed to improve treatment of these patients. However, it is not a standard treatment regime. The purpose of this study is to investigate the efficacy of physiotherapy treatment of shoulder function, pain and quality of life in patients who have undergone breast cancer surgery and axillary lymph node dissection.     

Autologous bone marrow transplantation in acute leukemia: a phase I study of in vitro treatment of marrow with 4- hydroperoxycyclophosphamide to purge tumor cells

This phase I study was conducted to determine the maximal safe concentration of 4-hydroperoxycyclophosphamide (4HC) that could be used for in vitro treatment of bone marrow from patients with acute leukemia undergoing autologous bone marrow transplantation. Concentrations of 40 to 120 micrograms/mL of 4HC were used in 30 patients with relapsed or high-risk acute leukemia and in six patients with nonleukemic malignancies. All patients received marrow-lethal cytoreductive therapy followed by infusion of the 4HC-treated marrow. Complete inhibition of granulocyte and macrophage colony-forming cells was obtained at 80 micrograms/mL. Nevertheless, only one transplant-related death and otherwise full hematologic recovery was observed at concentrations of 4HC up to 100 micrograms/mL. At 120 micrograms/mL, there were three transplant-related deaths, including two of the three patients who required the infusion of reserve marrow. Among the acute leukemia patients, three remain in complete remission at 1,337, 1,017, and 967 days after transplant. Among the nonleukemic patients, two remain in complete remission at 1,081 and 1,017 days after transplant. At the maximum safe concentration of 4HC (100 micrograms/mL), satisfactory hematologic recovery can be obtained, despite elimination of detectable hematopoietic progenitors.     

Differential induction of P-selectin expression on platelets by two cell separators during plateletpheresis and the effect of gender on the release of soluble P-selectin

BACKGROUND: Though a number of studies have elegantly characterized platelet activation during storage, less attention has been paid to the initial activation caused by different collection procedures. STUDY DESIGN AND METHODS: The effects of two blood cell separators on the initial activation of platelets were measured by flow cytometric analysis of P-selectin expression in 13 male donors on one cell separator (CS 3000 Plus) and 11 men and 9 women on the other (MCS 3P). In addition, the storage and release of soluble P-selectin (circulating P-selectin [cP-selectin]) by platelets were quantified, to determine whether the change in cP-selectin is a more sensitive marker for initial platelet activation, and the influence of gender on measured endpoints was evaluated. RESULTS: The CS 3000 Plus increased the percentage of P-selectin-positive platelets from a median of 3.4 percent before apheresis to 7.6 percent (p = 0.006) in platelet concentrates (PCs), whereas the MCS 3P did not (p = 0.002 between the two cell separators). When preapheresis cP-selectin levels were compared to those in apheresis PCs, cP-selectin increased from 51 to 101 ng per mL in plasma of CS 3000 Plus PCs, whereas cP-selectin levels increased from 53 to 78 ng per mL in MCS 3P PCs (men) and from 48 to 99 ng per mL in MSC 3P PCs (women) (p<0.005 for all). The relative increase in cP-selectin was higher in women than in men in MCS 3P PCs (p = 0.013). Concomitantly, the amount of P-selectin stored in platelets before apheresis decreased (p<0.025 for all). When donors undergoing apheresis on the MCS 3P were compared, the amount of P- selectin stored in the platelets of PCs was higher in men than women (p = 0.026). CONCLUSION: This trial shows 1) that initial activation of platelets obtained with the MCS 3P is less than that of platelets obtained with the CS 3000 Plus; 2) that the increase in cP-selectin is a more sensitive marker for initial platelet activation than the expression of P-selectin on the surface; and 3) that the relative amount of cP-selectin is higher in women than in men given the same stimulus. Differences in platelet activation by various cell separators and the sex of the donor may contribute to variability of PC quality.     

White cell reduction in platelet concentrates and packed red cells by filtration: a multicenter clinical trial. The Trap Study Group

BACKGROUND: Most previous studies on white cell (WBC) reduction by filtration have been small-scale studies conducted under tightly controlled laboratory conditions. Their results would be the ideal, rather than what might be expected during routine operation. STUDY DESIGN AND METHODS: To obtain information on routine filtration of blood components, data have been collected from a large-scale, ongoing, multicenter clinical trial designed to determine the effectiveness of WBC reduction in or ultraviolet B radiation of platelet concentrates before transfusion in preventing platelet alloimmunization and platelet transfusion refractoriness. The WBC content of blood components both before and after filtration was determined by automated cell counters and a manual propidium iodide-staining method, respectively. Platelet and red cell losses during filtration were measured. RESULTS: The average platelet losses after filtration were 24 +/? 15 percent and 20 +/? 9 percent for apheresis platelets and pooled platelets, respectively. The frequencies at which filtered platelet concentrates contained high levels of residual WBCs (> 5 × 10(6)) were 7 percent and 5 percent for apheresis platelets and pooled platelets, respectively. Further analysis of the platelet filtration data showed that greater numbers of total initial WBCs in the pooled platelets were associated with increased percentages of filtration failure (> 5 × 10(6) residual WBCs). For packed red cells, the average losses during filtration were 23 +/? 4 percent and 15 +/? 3 percent for CPDA-1 units and Adsol units, respectively. The frequencies at which filtered red cells contained > 5 × 10(6) residual WBCs were 2.7 percent for one type of filter and 0.3 percent for another type of filter. CONCLUSION: There were significant losses of platelets during filtration, which could add to the costs of WBC reduction and lead to possible increases in donor exposures. Filtration failures still occurred, despite careful observation of the standard filtration procedures. The number of total WBCs in pooled platelets before filtration has been identified as an important factor in determining the success of WBC reduction.     

经椎弓根人工骨植入并后路椎弓根钉内固定材料置入治疗胸腰椎爆裂骨折

目的:加用后路植骨融合减少并发症是国内外学者均认可的有效方法,使用中大多数为横突间植骨或椎间植骨,其植骨融合率不高,术后仍然存在丢失矫正角度的问题。拟验证采用椎弓根钉系统内固定材料置入配合人工骨经椎弓根植入在预防无神经损伤的胸腰椎爆裂性骨折术后并发症中的作用和应用价值。方法:①实验对象:于2004-03/2007-02吉林医药学院附属医院骨科采用后路椎弓根钉系统撑开复位内固定材料置入并用经椎弓根植入人工骨治疗无神经症状的胸腰椎爆裂性骨折患者26例。男15例,女11例,年龄22～岁,平均45岁。合并有骨质疏松688例。CT示椎体后壁不完整并有碎骨块压迫硬膜囊,椎管变窄20%～50%。经X射线片判定均有脊柱后凸畸形;术前Cobb角6°～30°,平均26°。术前伤椎前缘压缩率50%～70%,平均60%;后缘压缩10%～15%,平均11.5%。26例均为单一椎体损伤,损伤椎体:T1210例,L112例,L24例。②实验材料:椎弓根钉系统使用国产创伤钉系列,人工骨使用美国生物材料公司生产的Nova Bone,商品名固骼生,具有良好的组织相容性,可完全生物降解,机械强度高等优点;其成骨速度快,应用在骨缺损上能即刻增加骨强度,短时间内可产生大量新生骨,促进骨愈合,是一种较好的植骨材料。③实验评估:CT与X射线片评估Cobb角和椎体压缩率改善状况,是否存在矫正角度丢失及Nova Bone吸收降解状况,有无不良反应。VAS评分标准评估脊柱活动度,腰背痛及下肢痛情况。结果:26例患者术后疼痛均明显缓解,椎体高度和形态得到明显恢复,Cobb角平均改善11.5°,椎体压缩率改善50%。Nova Bone比较均匀分布于伤椎骨缺损间隙中,无泄漏现象发生。经平均20.5个月随访,疼痛均消失,骨折均达到满意复位并骨性愈合,Nova Bone均完全降解,无Cobb角明显加大,未发现明显并发症。结论:后路椎弓根钉系统固定材料置入加经椎弓根植入人工骨能即时增加椎体的骨容量和脊柱前柱的抗压稳定性,减少内固定因应力过大造成的断钉、断杆、椎体再压缩等并发症,是一种治疗胸腰椎爆裂性骨折预防矫正丢失的有效方法。     

艾灸大鼠天枢、气海穴对结肠成纤维细胞分泌胰岛素样生长因子Ⅰ、转化生长因子β1的调控作用

目的:研究显示,胰岛素样生长因子Ⅰ和转化生长因子β1与溃疡性结肠炎患者肠纤维化的形成关系密切。实验通过艾灸对大鼠结肠成纤维细胞分泌胰岛素样生长因子Ⅰ、转化生长因子β1的影响,探索艾灸防治溃疡性结肠炎肠纤维化机制。方法:实验于2004-05/2005-07在上海中医药大学实验动物室和国家中医药管理局针灸免疫三级实验室完成。①实验材料:SPF级雄性SD大鼠75只,体质量200g左右。②实验分组及处理:采用免疫学方法加局部刺激制备溃疡性结肠炎大鼠模型,随机将大鼠分为正常组、模型组、隔药灸组、温和灸组和西药组。隔药灸组、温和灸组选取天枢、气海穴分别进行隔药灸、温和灸治疗,西药组柳氮磺胺吡啶溶液灌胃治疗,模型组和正常组仅固定不做治疗。治疗结束后麻醉下处死大鼠,剖取结肠组织,分离并培养结肠成纤维细胞。③实验评估:用酶联免疫吸附法检测各组大鼠成纤维细胞上清液中胰岛素样生长因子Ⅰ、转化生长因子β1含量。结果:每组取8只进入结果分析。①造模大鼠结肠黏膜缺损,溃疡形成,胶原纤维增生,Ⅰ、Ⅲ、Ⅳ型胶原纤维排列紊乱,数量增多;肉芽组织、纤维组织增生。②模型组大鼠结肠成纤维细胞大量分泌转化生长因子β1、胰岛素样生长因子Ⅰ;与模型组比较,隔药饼灸、温和灸组大鼠转化生长因子β1分泌量减少(P<0.05,P<0.01),隔药饼灸、温和灸和西药组大鼠胰岛素样生长因子Ⅰ分泌量减少(P均<0.01)。结论:艾灸大鼠天枢、气海穴能抑制大鼠结肠成纤维细胞分泌促细胞外基质细胞因子胰岛素样生长因子Ⅰ、转化生长因子β1,减少细胞外基质的积聚,达到防治肠纤维化的作用。     

C-Reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: results from the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Augsburg Cohort Study, 1984 to 1992

BACKGROUND: Inflammatory reactions in coronary plaques play an important role in the pathogenesis of acute atherothrombotic events; inflammation elsewhere is also associated with both atherogenesis generally and its thrombotic complications. Recent studies indicate that systemic markers of inflammation can identify subjects at high risk of coronary events. METHODS AND RESULTS: We used a sensitive immunoradiometric assay to examine the association of serum C-reactive protein (CRP) with the incidence of first major coronary heart disease (CHD) event in 936 men 45 to 64 years of age. The subjects, who were sampled at random from the general population, participated in the first MONICA Augsburg survey (1984 to 1985) and were followed for 8 years. There was a positive and statistically significant unadjusted relationship, which was linear on the log-hazards scale, between CRP values and the incidence of CHD events (n=53). The hazard rate ratio (HRR) of CHD events associated with a 1-SD increase in log-CRP level was 1.67 (95% CI, 1.29 to 2. 17). After adjustment for age, the HRR was 1.60 (95% CI, 1.23 to 2. 08). Adjusting further for smoking behavior, the only variable selected from a variety of potential confounders by a forward stepping process with a 5% change in the relative risk of CRP as the selection criterion, yielded an HRR of 1.50 (95% CI, 1.14 to 1.97). CONCLUSIONS: These results confirm the prognostic relevance of CRP, a sensitive systemic marker of inflammation, to the risk of CHD in a large, randomly selected cohort of initially healthy middle-aged men. They suggest that low-grade inflammation is involved in pathogenesis of atherosclerosis, especially its thrombo-occlusive complications.     

Biliary strictures complicating pancreaticoduodenectomy

Summary Background. Biliary-enteric anastomotic strictures may complicate pancreaticoduodenectomy. Anastomotic ischaemia and reflux of gastric and enteric contents with secondary bacterobilia and cholangitis may contribute. Methods. Four patients (3 females, 1 male) with a mean age of 50 yr (range 26–73 yr) presented 1–12 yr following pancreaticoduodenectomy with features suggestive of biliary-enteric anastomotic stricture formation. These included recurrent cholangitis, obstructive jaundice, and liver abscess. Diagnosis was confirmed by percutaneous or endoscopic cholangiography. Endoscopic and radiological management were unsuccessful, and revision surgery in the form of a Roux-en-Y hepaticojejunostomy was required. Results. Three patients remain asymptomatic 10–30 mo postoperatively. Jaundice recurred at 15 mo in one patient owing to re-stricture formation and the development of secondary biliary cirrhosis; a liver transplantation is being considered. Conclusion. Early diagnosis and prompt management of biliary-enteric stricture is essential if secondary biliary cirrhosis is to be avoided. Definitive therapy is best accomplished with a Roux-en-Y hepaticojejunostomy that places the gastric and biliary anastomoses onto separate jejunal limbs.     

Myelination-related genes are associated with decreased white matter integrity in schizophrenia

Disruptions in white matter (WM) tract structures have been implicated consistently in the pathophysiology of schizophrenia. Global WM integrity – as measured by fractional anisotropy (FA) – is highly heritable and may provide a good endophenotype for genetic studies of schizophrenia. WM abnormalities in schizophrenia are not localized to one specific brain region but instead reflect global low-level decreases in FA coupled with focal abnormalities. In this study, we sought to investigate whether functional gene sets associated with schizophrenia are also associated with WM integrity. We analyzed FA and genetic data from the Mind Research Network Clinical Imaging Consortium to study the effect of multiple oligodendrocyte gene sets on schizophrenia and WM integrity using a functional gene set analysis in 77 subjects with schizophrenia and 104 healthy controls. We found that a gene set involved in myelination was significantly associated with schizophrenia and FA. This gene set includes 17 genes that are expressed in oligodendrocytes and one neuronal gene (NRG1) that is known to regulate myelination. None of the genes within the gene set were associated with schizophrenia or FA individually, suggesting that no single gene was driving the association of the gene set. Our findings support the hypothesis that multiple genetic variants in myelination-related genes contribute to the observed correlation between schizophrenia and decreased WM integrity as measured by FA.