Postoperative wound breakdown caused by pyoderma gangrenosum after bilateral simultaneous total knee arthroplasty

Pyoderma gangrenosum is a noninfective necrosis of dermal tissues. Rarely, it occurs after surgery or trauma. However, lack of awareness and its striking similarity to a clinical picture of sepsis usually delay diagnosis and initiation of the correct management. We describe a unique case of its occurrence in both surgical wounds after bilateral total knee arthroplasty and discuss the differential diagnoses and management.     

Anti-angiogenic factors and pre-eclampsia in type 1 diabetic women

Aims/hypothesis  Elevated anti-angiogenic factors such as soluble fms-like tyrosine kinase 1 (sFlt1), a soluble form of vascular endothelial growth factor receptor, and endoglin, a co-receptor for TGFβ1, confer high risk of pre-eclampsia in healthy pregnant women. In this multicentre prospective study, we determined levels of these and related factors in pregnant women with type 1 diabetes, a condition associated with a fourfold increase in pre-eclampsia. Methods  Maternal serum sFlt1, endoglin, placental growth factor (PlGF) and pigment epithelial derived factor were measured in 151 type 1 diabetic and 24 healthy non-diabetic women at each trimester and at term. Results  Approximately 22% of the diabetic women developed pre-eclampsia, primarily after their third trimester visit. In women with pre-eclampsia (diabetic pre-eclampsia, n = 26) vs those without hypertensive complications (diabetic normotensive, n = 95), significant changes in angiogenic factors were observed, predominantly in the early third trimester and prior to clinical manifestation of pre-eclampsia. Serum sFlt1 levels were increased approximately twofold in type 1 diabetic pre-eclampsia vs type 1 diabetic normotensive women at the third trimester visit (p < 0.05) and the normal rise of PlGF during pregnancy was blunted (p < 0.05). Among type 1 diabetic women, third trimester sFlt1 and PlGF were inversely related (r² = 42%, p < 0.0001). Endoglin levels were increased significantly in the diabetic group as a whole vs the non-diabetic group (p < 0.0001). Conclusions/interpretation  Higher sFlt1 levels, a blunted PlGF rise and an elevated sFlt1/PlGF ratio are predictive of pre-eclampsia in pregnant women with type 1 diabetes. Elevated endoglin levels in women with type 1 diabetes may confer a predisposition to pre-eclampsia and may contribute to the high incidence of pre-eclampsia in this patient group.     

Bioactive properties of iron-containing carbon monoxide-releasing molecules

Carbon monoxide-releasing molecules (CO-RMs) are compounds capable of delivering controlled amounts of CO within a cellular environment. Ruthenium-based carbonyls [tricarbonyldichloro ruthenium(II) dimer and tricarbonylchloro-(glycinato)ruthenium(II)] and boronacorbonates (sodium boranocarbonate) have been shown to promote vasodilatory, cardioprotective, and anti-inflammatory activities in a variety of experimental models. Here, we extend our previous studies by showing that eta-4-(4-bromo-6-methyl-2-pyrone)tricarbonyl iron (0) (CORM-F3), an irontricarbonyl complex that contains a 2-pyrone motif, liberates CO in vitro and exerts pharmacological actions that are typical of CO gas. Specifically, CORM-F3 caused vasorelaxation in isolated aortic rings and inhibited the inflammatory response (e.g., nitrite production) of RAW264.7 macrophages stimulated with endotoxin in a dose-dependent fashion. By analyzing the rate of CO release, we found that when the bromide at the 4-position of the 2-pyrone CORM-F3 is substituted with a chloride group [eta-4-(4-chloro-6-methyl-2-pyrone)tricarbonyl iron (0) (CORM-F8)], the rate of CO release is significantly decreased (4.5-fold), and a further decrease is observed when the 4- and 6-positions are substituted with a methyl group [eta-4-(4-methyl-6-methyl-2-pyrone)tricarbonyl iron (0) (CORM-F11)] or a hydrogen [eta-4-(4-chloro-2-pyrone)tricarbonyl iron (0) (CORM-F7)], respectively. Interestingly, the compounds containing halogens at the 4-position and the methyl at the 6-position of the 2-pyrone ring (CORM-F3 and CORM-F8) were found to be less cytotoxic compared with other CO-RMs when tested in RAW246.7 macrophages. Thus, iron-based carbonyls mediate pharmacological responses that are achieved through liberation of CO and the nature of the substituents in the organic ligand have a profound effect on both the rate of CO release and cytotoxicity.     

The efficacy of a school-based caries preventive program: a 4-year study

Abstract:  This longitudinal study aimed at testing the efficacy of a school-based caries preventive program, by comparing dental caries status of two groups, a study group (436 children) and a control group (420 children) over a period of 4 years. The study group received a preventive program which consisted of intensive oral hygiene instructions sessions, and supervised daily tooth brushing using fluoridated tooth paste in schools. The control group received only oral hygiene instructions sessions. Annual dental examination to record dental caries status, using Decayed Missed Filled Teeth Index (DMFT) and deft, was conducted for both groups over a period of 4 years. At the end of the fourth year the efficacy of the program was tested by comparing the DMFT and deft indices for the two groups using Pearson chi-square test and Cochran–Mantel–Haenzele test. The level of significance was set at P  < 0.05. The results after 4 years showed that the caries status of the children in the study group was better than that of the control group. The difference was statistically significant ( P -value 0.001). The estimates of relative risk values also showed that children in the control group are 3.1 and 6.4 times at higher risk of having dental caries than those in the study group for age group 12 and 6 respectively. This study proves that supervised daily tooth brushing using fluoridated toothpaste is successful in controlling dental caries in children.     

Kin KeeperSM: Design and baseline characteristics of a community-based randomized controlled trial promoting cancer screening in Black,Latina, and Arab women

BackgroundAlthough breast and cervical cancer deaths have declined due to early screening, detection, and more effective treatment, racial and ethnic disparities persist. This paper describes the study design and baseline characteristics of a randomized controlled trial (RCT) evaluating the effectiveness of the Kin Keeper^SM Cancer Prevention Intervention, a family-focused educational intervention for underserved women applied in a community-based setting to promote health literacy and screening adherence to address cancer disparities.MethodsFemale public health community health workers (CHWs) were trained to administer the intervention. They recruited female clients from their public health program caseload and asked each to assemble two to four adult female family members for the breast and cervical cancer home-based education sessions the CHWs would deliver in English, Spanish or Arabic. We randomized the clients into the kin keeper group (treatment) or the participant client group (control).ResultsComplete data were obtained on 514 Black, Latina, and Arab women. Close to half were unemployed and had yearly family income below $20,000. Thirty-four percent had no medical insurance, and 21% had diabetes. Almost 40% had no mammography in the last year. Treatment and control groups were similar on most sociodemographics but showed differences in breast and cervical screening history.ConclusionsThis innovative study demonstrates the implementation of an RCT using community-based participatory research, while delivering cancer prevention education across woman's life span with women not connected to the health care system.     

玻片法单人份免疫分型试剂盒在白血病诊断中的应用

0引言白血病免疫分型是指用已知的单克隆抗体(单抗)鉴定细胞表面或胞质内的分化抗原的方法.该方法的临床应用有利于白血病的鉴别及诊断.我们采用单人份免疫分型试剂盒对128例白血病患者进行了免疫分型.