Cyclosporine withdrawal from a mycophenolate mofetil-containing immunosuppressive regimen in stable kidney transplant recipients: a randomized,controlled study

BACKGROUND: Long-term maintenance immunosuppression with cyclosporine (CsA) is associated with chronic transplant nephropathy and adverse effects on blood pressure and lipid profile. Several nonrandomized studies suggest that CsA might safely be withdrawn from immunosuppressive regimens containing mycophenolate mofetil (MMF; CellCept). METHODS: A randomized, controlled study with 187 patients enrolled from 21 centers was conducted to compare CsA withdrawal with ongoing CsA therapy in stable renal transplant recipients receiving a triple-drug immunosuppressive regimen of MMF (2 g/day), CsA (Neoral), and corticosteroids. The primary endpoint was creatinine clearance at 6 months after complete withdrawal. RESULTS: In the intent-to-treat population, CsA withdrawal was associated with lower total cholesterol and low-density lipoprotein cholesterol (-0.3 mmol/L, P=0.02; -0.4 mmol/L, P=0.015). There was a trend toward improved creatinine clearance (4.5 mL/min, P=0.16) and serum creatinine (-1 vs. +4 micromol/L, P=0.34). In the per-protocol population, which excluded patients with acute rejections, the improvements in creatinine clearance and serum creatinine were statistically significant (7.5 mL/min, P=0.02; -11 vs. +4 micromol/L, P=0.0003). Reversible acute rejections, the majority of which were mild, occurred in nine CsA withdrawal versus two CsA continuation patients (10.6% vs. 2.4% of each group, P=0.03), with no graft loss. CONCLUSION: Withdrawal of CsA from an MMF-containing triple-drug immunosuppressive regimen improves renal function and lipid profile at the cost of a modest increase in acute rejections, without graft loss.     

创伤性胫前皮肤缺损骨不连医源性因素分析及防治

目的探讨外伤性胫前皮肤缺损骨不连医源性因素、治疗方法及预防措施.方法对136例外伤性胫前皮肤缺损,进行回顾性研究,分析医源性因素,提出预防措施,随访治疗效果.采用7种局部转移皮瓣和6种游离皮瓣移植治疗皮肤缺损,骨不连、骨缺损均采用带血管的骨移植.结果136例中121例得到6～28个月随访,平均17个月.局部皮瓣转移全部成活,游离皮瓣移植中7例术后发生血管危象,经探查4例成活,3例失败,二期以带胫后血管的对侧小腿内侧皮瓣为受区血管蒂的皮瓣移植修复治愈.骨不连、骨缺损行骨移植后均在术后3个月愈合,骨髓炎治愈.结论医源性技术缺陷是外伤性胫前皮肤缺损骨不连的重要因素,针对各种不同的因素进行预防、合理治疗可获得满意效果.     

Goitrogenesis during pregnancy and neonatal hypothyroxinaemia in a borderline iodine sufficient area

OBJECTIVE: Severe iodine deficiency disorders (IDDs) may have been eradicated in many parts of the world, but milder forms still exist and may escape detection. We evaluated the impact of pregnancy on the maternal and fetal thyroid axis in Hong Kong, a coastal city in southern China with borderline iodine intake. DESIGN: A prospective study performed in a maternity hospital. PATIENTS: Two hundred and thirty pregnant women were prospectively studied and their neonates assessed at birth. MEASUREMENTS: Urine iodine concentration, thyroid function tests and thyroid volume (TV) by ultrasound were determined in the mothers during pregnancy and up to 3 months postpartum and in the neonates. RESULTS: Increased urinary iodine concentration was seen from first trimester onwards and the proportion of women having urine iodine concentration of < 0.4 micromol/l decreased from 11.3% in the first trimester to 4.7% in the third trimester. There was progressive reduction in circulating fT4 and fT3 concentrations and free thyroxine index (FTI) with increasing gestation and the percentage of women having subnormal levels at term were 53.2%, 61.1% and 4.8%, respectively. The serum TSH concentration during pregnancy doubled towards term. In the first trimester, multiparous women had significantly larger TV than the nulliparous women (P < 0.001). By the third trimester, TV had increased by 30% (range 3-230%) so that the goitre incidence was 14.1%, 21.8%, 25.9% during the three trimesters of pregnancy, and 24.3% and 21.9% at 6 weeks and 3 months postpartum (ANOVA, P < 0.05). The change in thyroid volume during pregnancy correlated positively with the change in thyroglobulin (r = 0.225, P < 0.002) and negatively with urinary iodine concentration (r = - 0.149, P < 0.02). Fourteen women with excessive thyroidal stimulation in the second trimester (defined as those with thyroglobulin (Tg) concentrations in the highest tertile and FTI in the lowest tertile) were found to have lower urine iodine concentrations and larger TV (both P < 0.005) throughout pregnancy, and their neonates had higher cord TSH (P < 0.05), Tg (P < 0.05) and slightly larger TV (P = 0.06) as compared to the findings in 216 pregnant women without evidence of thyroid stimulation. Seven neonates (50%) born to these women had subnormal fT4 levels at birth. CONCLUSION: In a borderline iodine sufficient area, pregnancy posed an important stress resulting in higher rates of maternal goitrogenesis as well as neonatal hypothyroxinaemia and hyperthyro- trophinaemia. An adequate iodization program is necessary to eliminate iodine deficiency disorders during pregnancy.     

舒芬太尼复合氟比洛芬酯用于全髋关节置换术术后静脉自控镇痛的效果

目的:观察舒芬太尼复合氟比洛芬酯用于全髋关节置换术术后静脉自控镇痛(PCIA)的效果。方法:择期在腰硬联合麻醉下行全髋关节置换手术患者60例,其中男28例、女32例,年龄50~68岁,体重50~75 kg,ASAⅠ或Ⅱ级。术后PCIA随机分为两组(n=30):舒芬太尼组(A组)和舒芬太尼+氟比洛芬酯组(B组)。两组均采用负荷量+持续剂量+自控给药的模式,负荷量:A组为舒芬太尼5μg+昂丹司琼4mg,B组为舒芬太尼5μg+氟比洛芬酯50 mg+昂丹司琼4 mg;持续剂量为2 m L/h,按压剂量为2 m L/次、锁定时间为15 min;镇痛液配方:A组为舒芬太尼150μg+昂丹司琼8 mg,B组为舒芬太尼100μg+氟比洛芬酯150 mg+昂丹司琼8mg,两组均用0.9%氯化钠注射液稀释至100 m L。评估两组患者术后镇痛开始后2(T1)、4(T2)、8(T3)、24(T4)、48 h(T5)各时间点的疼痛视觉模拟评分(VAS)、Remesay镇静评分。同时记录术后镇痛48 h内总按压次数及不良反应的发生情况。结果:两组术后镇痛各观察时点的VAS评分、Remesay镇静评分、48 h总按压次数,组间比较差异无统计学意义(P>0.05)。但B组患者恶心(0%)、呕吐(0%)、头晕(3.3%)不良反应发生率低于A组(10%、6.8%、26.7%)(P<0.05)。结论:舒芬太尼复合氟比洛芬酯用于全髋关节置换术术后静脉自控镇痛,镇痛效果好,且舒芬太尼用量少及不良反应发生率低。     

Genital human papillomavirus infection in Panama City prostitutes

Little is known of the natural history of genital human papillomavirus (HPV) infections in women from high-risk populations. Samples were collected from 183 Panama City prostitutes and assessed for HPV (filter in situ DNA hybridization) and for sexually transmitted agents. The cohort was followed for 8 mo; 51% of subjects completed four monthly return visits and 16% were sampled eight times. The proportion of women found infected with HPV increased significantly with increasing numbers of consecutive samples tested; 38 (21%) of 183 women were positive after one visit and 46 (82%) of 56 who completed six visits were infected. The pattern of viral detection over time was not random, which implied that most prostitutes were persistently infected with genital HPVs and that either scattered foci of infection or periodic reactivation of latent virus occurred. Our findings suggest that multiple sampling is necessary to accurately estimate HPV infection rates and to define whether patterns of DNA expression are present.     

Association of body image and health beliefs with health behaviors in patients with diabetes: a cross-sectional study

Purpose The purpose of this study was to investigate relationships between body image, health beliefs, and health behavior in patients with diabetes classified according to body mass index (BMI). Methods A cross-sectional study was conducted in a community hospital between January and April 2010. One-hundred-sixty-eight patients with diabetes were enrolled. Main measure was the previously published and validated Health Belief Questionnaire. Data were analyzed and compared between two groups, one with BMI ≥ 24 Kg/m(2) and another with BMI < 24 Kg/m(2). Results Perceived body image affected health behavior of patients with BMI ≥ 24 Kg/m(2) but did not affect health behavior in patients with BMI < 24 Kg/m(2). Multivariate analysis found a positive association between health behavior and appearance evaluation and between health behavior and health evaluation in high BMI group. No significant association was found between body image and health behavior in the low BMI group. Patients with high BMI had lower body image than patients with low BMI as demonstrated by results of appearance evaluation, health evaluation, prevention behavior, and benefits. Conclusions Perceived body image and health beliefs are associated with self-reported health behavior among patients with diabetes with BMI measurement greater than 24 Kg/m(2). Diabetes educators may apply the findings of this study and the Health Belief Questionnaire to instruct and monitor patients with diabetes about self management behaviors.     

The Clearance of High-Risk Human Papillomavirus is Sooner After Thin Loop Electrosurgical Excision Procedure (t-LEEP)

Abstract

Purpose/aim of the study: To investigate high-risk human papillomavirus (HPV) infection clearance following thin loop electrosurgical excision procedure (t-LEEP) among patients with cervical benign lesion. Materials and Methods: This retrospective study analyzed clinical data from patients with cervical benign lesion and HPV infection, who had undergone t-LEEP (T-Group), compared with patients with HPV infection undergone no treatment (NT-Group). Both groups attended regular follow-up between January 2008 and January 2012. Kaplan–Meier analysis was used to compare the HPV clearance time. Results: The average clearance time was 7.7?months (M) (95% confidence interval [CI]: 6.5–8.9 M) in T-Group, and 10.4?M (95%CI: 9.4–11.3 M) in NT-Group, with significant difference between groups (p?=?0.003). Among patients with low viral load, the HPV clearance times were 7.6?M (95%CI: 6.3–9.0 M) in T-Group and 9.7?M (95%CI: 8.6–10.8 M) in NT-Group (p?=?0.042). Among patients with high viral load, the HPV clearance times were 8.0?M (95%CI: 5.3–10.6 M) in T-Group and 11.4?M (95%CI: 9.7–13.1 M) in NT-Group (p?=?0.041). The average time of HPV clearance in T-Group was shorter than NT-Group in all age groups, with significant differences in ≤29Y-group (p?=?0.008) and 30–39Y-group (p?=?0.005). The accumulated clearance rate of HPV infection at sixth month and 12th month were 24.5% and 67.9% in T-Group, 7.8% and 43.1% in NT-Group, with significant differences (p?=?0.001 at 6th month, p?=?0.032 at 12th month). Conclusions: T-LEEP accelerates the clearance of high-risk HPV infection and make the HPV infection rates dropped rapidly in the first year.     

PET imaging of acetylcholinesterase inhibitor‐induced effects on α4β2 nicotinic acetylcholine receptor binding

Acetylcholinesterase inhibitors (AChEIs) are drugs that increase synaptic acetylcholine (ACh) concentrations and are under investigation as treatments for symptoms accompanying Alzheimer's disease. The goal of this work was to use PET imaging to evaluate alterations of in vivo α4β2 nicotinic acetylcholine receptor (nAChR) binding induced by the AChEIs physostigmine (PHY) and galanthamine (GAL). The α4β2 nAChR‐specific radioligand [¹⁸F]nifene was used to examine the effects of 0.1–0.2 mg/kg PHY, 5 mg/kg GAL, and saline in three separate experiments all performed on each of two rat subjects. A 60‐min bolus‐infusion protocol was used with drug administered after 30 min. Data from the thalamus and cortex were analyzed with a graphical model accounting for neurotransmitter activation using the cerebellum as a reference region to test for transient competition with bound [¹⁸F]nifene. Significant [¹⁸F]nifene displacement was detected in both regions during one PHY and both GAL studies, while no significant competition was observed in both saline studies. This preliminary work indicates the viability of [¹⁸F]nifene in detecting increases in synaptic ACh induced by AChEIs. Synapse 67:882–886, 2013. © 2013 Wiley Periodicals, Inc.     

Prevalence of thoracic scoliosis in adults 25 to 64 years of age detected during routine chest radiographs

Purpose

To investigate the prevalence of thoracic scoliosis and determine the effect of both age and gender on coronal curve magnitude among asymptomatic adults aged 25–64 years old, using standing posterior-anterior chest radiographs.

Methods

This was a retrospective, cross-sectional study evaluating 500 randomly selected digital posterior-anterior chest radiographs taken at a single institution on an outpatient basis between January 2010 and December 2011. Males (n = 184) and females (n = 316) ranged in age from 25 to 64 years. Patients with symptoms of back pain; including a history of back pain, spinal instrumentation, or known pre-existing spinal disease were excluded. Radiographs were evaluated using Centricity PACS Web Diagnostic 2.1 system (General Electric Co. Fairfield, CT). Coronal Cobb angle measurements of the thoracic spine were quantified by the authors, with scoliosis defined as coronal curves greater than 10°. Curvatures were subdivided into groups: a control group with coronal curves less than 10°, curves measuring 10° to 19°, 20° to 29°, and greater than 30°. The effect of age and gender on curve magnitude was examined using Pearson correlation analysis and linear regression analysis.

Results

There was a 13.4 % (67 patients) prevalence of thoracic scoliosis. The prevalence among asymptomatic males was 10.9 %, while the prevalence among asymptomatic females was 14.9 %. 11.6 % demonstrated a coronal curvature between 10° and 19° (58 patients), 1.6 % between 20° and 29° (8 patients), and 0.2 % greater than 30° (1 patient). Age and gender were not found to be significant independent predictors of curve severity.

Conclusions

We found a 13.4 % prevalence of thoracic scoliosis among asymptomatic adults aged 25–64 years on routine outpatient chest radiographs. 11.6 % of patients demonstrated a coronal curvature between 10° and 19°. Unlike prior studies evaluating asymptomatic thoracic curves in elderly patients, age and gender did not significantly affect curve magnitude in our younger cohort. These data may provide a reference point to help clinicians counsel asymptomatic patients diagnosed with thoracic scoliosis on routine chest radiographs.