Intracervical lidocaine gel for intrauterine device insertion: a randomized controlled trial

BackgroundPain during intrauterine device (IUD) insertion can be a barrier to initiation. Clinical trials have found misoprostol and nonsteroidal drugs to be ineffective (Am J Obstet Gynecol 2006;195:1272–1277, Hum Reprod 2011;26:323–329, Hum Reprod 2007;22:2647–2652). One study suggested that 2% lidocaine gel decreased pain; however, study design problems limit its validity (Brit J Fam Plann 1996;22:177–180). We tested whether intracervical 2% lidocaine gel decreased insertion pain compared to placebo.Study DesignWe planned a randomized, double-blinded clinical trial of 200 women. We placed 2% lidocaine gel or placebo in the cervix prior to uterine sounding. Participants rated pain by marking a 100-mm visual analogue scale at four time points.ResultsWe randomized 200 participants and placed 197 IUDs. Pain was greatest at uterine sounding and similar between groups: placebo group mean 51.6 mm (SD 25), lidocaine group mean 55.5 mm (SD 30, p=.33). Stratified analyses accounting for parity showed no treatment effect. Multivariable analyses identified longer time since last pregnancy, lower parity and higher anticipated pain as predictors of pain during sounding, and dysmenorrhea and the levonorgestrel IUD as additional predictors during IUD insertion.ConclusionsIntracervical 2% lidocaine gel does not decrease IUD insertion pain. Understanding predictors of increased pain may help providers with preprocedure counseling.     

Early Changes in Bone Density,Microarchitecture, Bone Resorption,and Inflammation Predict the Clinical Outcome 12 Weeks After Conservatively Treated Distal Radius Fractures: An Exploratory Study

Fracture healing is an active process with early changes in bone and inflammation. We performed an exploratory study evaluating the association between early changes in densitometric, structural, biomechanical, and biochemical bone parameters during the first weeks of fracture healing and wrist‐specific pain and disability at 12 weeks in postmenopausal women with a conservatively treated distal radius fracture. Eighteen patients (aged 64 ± 8 years) were evaluated at 1 to 2 and 3 to 4 weeks postfracture, using high‐resolution peripheral quantitative computed tomography (HR‐pQCT), micro‐finite element analysis, serum procollagen type‐I N‐terminal propeptide (P1NP), carboxy‐terminal telopeptide of type I collagen (ICTP), and high‐sensitive C‐reactive protein (hsCRP). After 12 weeks, patients rated their pain and disability using Patient Rated Wrist Evaluation (PRWE) questionnaire. Additionally, Quick Disability of the Arm Shoulder and Hand (QuickDASH) questionnaire and active wrist range of motion was evaluated. Linear regression models were used to study the relationship between changes in bone parameters and in hsCRP from visit 1 to 2 and PRWE score after 12 weeks. A lower PRWE outcome, indicating better outcome, was significantly related to an early increase in trabecular bone mineral density (BMD) (β ?0.96 [95% CI ?1.75 to ?0.16], R² = 0.37), in torsional stiffness (?0.14 [?0.28 to ?0.004], R² = 0.31), and to an early decrease in trabecular separation (209 [15 to 402], R² = 0.33) and in ICTP (12.1 [0.0 to 24.1], R² = 0.34). Similar results were found for QuickDASH. Higher total dorsal and palmar flexion range of motion was significantly related to early increase in hsCRP (9.62 [3.90 to 15.34], R² = 0.52). This exploratory study indicates that the assessment of early changes in trabecular BMD, trabecular separation, calculated torsional stiffness, bone resorption marker ICTP, and hsCRP after a distal radius fracture provides valuable information regarding the 12‐week clinical outcome in terms of pain, disability, and range of motion and validates its use in studies on the process of early fracture healing. © 2014 American Society for Bone and Mineral Research.     

Oral zinc as initial therapy in Wilson''s disease: two years of continuous treatment in a 10-year-old child

Two years of continuous therapy promoted a significant overall amelioration in a 10-year-old boy affected by an hepatic form of Wilson's disease in which zinc sulphate was the sole therapy. In particular, liver function returned to normal and hepatic histology also improved. The parameters characterizing copper metabolism were kept under good control, and a decrease in copper concentration was found in both erythrocytes and liver. The copper balance study performed during the 25th month of treatment showed that oral zinc was still efficiently inhibiting the intestinal absorption of copper. No side effects have been reported so far.     

Computerized cry analysis in infants affected by severe protein energy malnutrition

A new method of computerized cry analysis has been utilized to evaluate the cries of infants affected by severe protein energy malnutrition. We studied 17 Kenian babies affected by severe malnutrition for more than four months (9 cases of marasmus and 8 of kwashiorkor) and a control group of 17 well-nourished babies. The cries of the malnourished children showed lower inter-utterance variability, formants' frequencies and cry score. assigned by the Infant Cry Modulation Assessment Scale. The melodic pattern was more often flat, rising or falling-rising, when compared to the cries of the well-nourished babies. We hypothesize that these differences reflect the state of brain damage associated with protein energy malnutrition. No differences were found between the cries of infants affected by marasmus and those affected by kwashiorkor, between the cries recorded before and after nutritional therapy and between the first cries of malnourished children who subsequently died during hospitalization and those of infants who survived.     

骨髓间质干细胞分泌胶质源性神经生长因子及对1-甲基4-苯基吡啶离子诱导PC12细胞凋亡的干预

目的:收集体外培养、纯化的骨髓间质干细胞条件培养液,检测其对多巴胺能神经元有保护作用的胶质源性神经生长因子分泌情况,并观察对1-甲基4-苯基吡啶离子诱导的PC12细胞凋亡的保护作用。方法:实验于2005-05/2006-10在中国医科大学附属一院神经内科实验室完成。①PC12细胞由协和医科大学细胞培养中心提供。1-甲基4-苯基吡啶离子(Sigma,USA,批号3707312)。②选取清洁级SD大鼠20只,麻醉后取股骨和胫骨,去净肌肉取骨髓,按1010L-1接种于含体积分数为0.2胎牛血清的低糖型DMEM培养基中,通过弃悬浮细胞及换液后可得到较纯的骨髓间质干细胞。培养第10天胰蛋白酶消化传代,当第2代细胞扩增至铺满瓶底80%时,改用含体积分数为0.05胎牛血清的低糖型DMEM条件培养液,48h后收集培养液,经超滤浓缩系统(截留分子量为10000)浓缩10倍后过滤除菌。③骨髓间充质干细胞接种于24孔板内,贴壁后多聚甲醛固定,磷酸盐缓冲液漂洗,免疫荧光法鉴定骨髓间充质干细胞表面抗原的表达。骨髓间充质干细胞消化后进行细胞计数,按1×108L-1接种于75cm培养瓶,加入含体积分数为0.2胎牛血清的DMEM培养液20mL,于培养第5,10天采用ELISA法测定细胞培养上清液中的胶质源性神经生长因子含量。④PC12细胞置于RPMI1640培养液中,内含体积分数为0.1的马血清和0.05的胎牛血清,汇集至80%时进行传代接种,液氮罐中贮存备用。实验前首先置换培养液,使血清浓度降至为仅含0.01马血清和0.01胎牛血清,24h后将培养的细胞分为4组:空白对照组,在细胞培养体系中不加入任何药物;骨髓间充质干细胞上清液组,接种后24h在细胞培养体系中分别加入骨髓间充质干细胞上清液30,60,120μL;1-甲基4-苯基吡啶离子组,接种后24h分别加入1-甲基4-苯基吡啶离子,使终浓度分别为100,200,400μmol/L;联合组,接种后24h加入200μmol/L1-甲基4-苯基吡啶离子,24h后再分别给予骨髓间充质干细胞上清液30,60,120μL。⑤各组细胞于给药后24,48h,流式细胞术检测PC12细胞的凋亡率;通过免疫细胞化学法和RT-PCR法检测PC12细胞半胱氨酸天冬氨酸蛋白酶3蛋白和mRNA的表达。结果:①骨髓间充质干细胞表面抗原鉴定:骨髓间充质干细胞可在体外分离扩增,其表面抗原CD45呈阴性,而CD44表达阳性。②骨髓间充质干细胞培养上清液中胶质源性神经生长因子水平检测:第5,10天培养上清液中的胶质源性神经生长因子浓度为(44.57±5.96)ng/L和(45.41±6.33)ng/L,差异无显著性意义(P>0.05)。③PC12细胞凋亡情况:联合组200μmol/L1-甲基4-苯基吡啶离子作用PC12细胞24h后,细胞凋亡率为(42.34±3.21)%;加入30,60,120μL骨髓间充质干细胞上清液处理24h后,细胞凋亡率分别降为(31.96±2.89)%,(17.89±1.78)%,(10.08±0.91)%,差异有显著性意义(P<0.05)。联合组药物作用48h与24h情况相似。④给药后各组半胱氨酸天冬氨酸蛋白酶3蛋白及mRNA的表达:联合组半胱氨酸天冬氨酸蛋白酶3蛋白和mRNA水平均明显低于1-甲基4-苯基吡啶离子组(t=0.05～0.32,P均<0.05)。结论:骨髓间充质干细胞能够分泌胶质源性神经生长因子,对1-甲基4-苯基吡啶离子诱导的PC12细胞凋亡产生保护作用。这种保护作用的强弱与其浓度有关,具体作用机制可能是通过抑制半胱氨酸天冬氨酸蛋白酶3蛋白和mRNA水平实现的。     

木通马兜铃化学成分研究

从木通马兜铃(Aristolochia manshuriensis Kom)茎皮中分得一个新化合物(5),经光谱(IR,UV,HRMS,^{1HNMR,NOEDS)鉴定为3,4-二甲氧基-10-硝基菲-1-羧酸甲酯,命名为马兜铃酸BII甲酯。另11个已知化合物是马兜铃酸Ⅰ,Ⅱ,Ⅲa,Ⅳ,Ⅳa,对羟基桂皮酸,β-谷甾醇,豆甾烷-3,6-二酮,6-羟基-豆甾-4-烯-3-酮,胡萝卜甙,二十八酸甘油单酯;其中二十八酸甘油单酯为首次从该属植物中分得。}