Sperm quality improvement after natural anti-oxidant treatment of asthenoteratospermic men with leukocytospermia

Aim： To study the immune-modulating and anti-oxidant effects of beta-glucan, papaya, lactoferrin, and vitamins C and E on sperm characteristics of patients with asthenoteratozoospermia associated with leucocytosis. Methods： Fifty-one patients referred to our Sterility Center for semen analysis were selected. Sperm parameters were assessed before and after patient＇s treatment with beta-glucan, lactoferrin, papaya, and vitamins C and E. DNA damage was assessed by the acridine orange test and sperm structural characteristics were evaluated by transmission electron microscopy. Results： After 90 days of treatment, an increase in the percentage of morphologically normal sperm （17.0 ± 5.2 vs. 29.8 ± 6.5） and total progressive motility （19.0± 7.8 vs. 34.8 ± 6.8） were detected. Structural sperm characteristics as well as chromatin integrity were also improved after treatment. In terms of leukocyte concentration in seminal fluid, a significant reduction was recorded （2.2 ± 0.9 vs. 0.9± 0.2）. Conclusion： The treatment of an inflammatory process by the synergic action of immune modulators and anti-oxidants could protect sperm during maturation and migration, leading to improved sperm function. （Asian JAndrol 2008 Mar;. 10： 201-206）     

桥接钢板治疗长管状骨的高能量损伤

目的探讨应用桥接钢板治疗长管状骨高能量损伤的临床疗效。方法应用桥接钢板的形式治疗长管状骨的高能量损伤37例。其中股骨粉碎性骨折12例,胫腓骨粉碎性骨折17例,肱骨粉碎性骨折3例,尺桡骨粉碎性骨折5例。结果全部病例得到随访,时间45d～2年,1年内骨性愈合34例,延迟愈合3例,无骨不连病例。根据自定的长管状骨愈合评价标准,本组优21例,良13例,中3例。结论长管状骨的高能量损伤骨折形式复杂,治疗较棘手,应用桥接钢板的形式进行治疗可最大限度地保留骨折部的血运,有利于骨折的按期愈合及减少并发症。     

Surgeon energy expenditure during total joint arthroplasty

Although there is extensive literature related to total hip arthroplasty (THA) and total knee arthroplasty (TKA), most of this research has been devoted to analyzing patient outcomes and complications. There are no published articles to date investigating the energy expenditure of the surgeon during these procedures. Using a SenseWear Pro(2) Armband, energy expenditure measured as energy expended during 22 primary THAs or TKAs by a single surgeon was recorded. Total hip arthroplasty required a greater expenditure of energy than TKA (P < .05). No significant trend was detected when comparing patient body mass index to the number of calories used by the surgeon. The physiologic demands placed upon the surgeon for various procedures should be recognized and is an additional factor to consider when determining procedure reimbursement.     

埃博拉病毒病研究的现状和思考

埃博拉病毒病（ Ebola virus disease）是一种急性出血性传染病,主要通过接触传播,临床表现为突起发热、肌肉酸痛、腹泻、出血和多脏器损害,伴随外周血白细胞、血小板计数降低等。埃博拉病毒是人类历史上最致命的病毒之一,人感染后病死率在50％～90％,被世界卫生组织（ WHO）列为生物安全第四级（ Biosafety level 4, BSL-4）病毒,同时也被视为生物恐怖工具之一。     

Accuracy of the field triage protocol in selecting severely injured patients after high energy trauma

Background

For optimal treatment of trauma patients it is of great importance to identify patients who are at risk for severe injuries. The Dutch field triage protocol for trauma patients, the LPA (National Protocol of Ambulance Services), is designed to get the right patient, in the right time, to the right hospital. Purpose of this study was to determine diagnostic accuracy and compliance of this triage protocol.

Study design

Triage criteria were categorised into physiological condition (P), mechanism of trauma (M) and injury type (I). A retrospective analysis of prospectively collected data of all high-energy trauma patients from 2008 to 2011 in the region Central Netherlands is performed. Diagnostic parameters (sensitivity, specificity, negative predictive value, positive predictive value) of the field triage protocol for selecting severely injured patients were calculated including rates of under- and overtriage. Undertriage was defined as the proportion of severely injured patients (Injury Severity Score (ISS) ≥ 16) who were transported to a level two or three trauma care centre. Overtriage was defined as the proportion of non-severely injured patients (ISS < 16) who were transported to a level one trauma care centre.

Results

Overall sensitivity and specificity of the field triage protocol was 89.1% (95% confidence interval (CI) 84.4–92.6) and 60.5% (95% CI 57.9–63.1), respectively. The overall rate of undertriage was 10.9% (95%CI 7.4–15.7) and the overall rate of overtriage was 39.5% (95%CI 36.9–42.1). These rates were 16.5% and 37.7%, respectively for patients with M+I−P−. Compliance to the triage protocol for patients with M+I−P− was 78.7%. Furthermore, compliance in patients with either a positive I+ or positive P+ was 91.2%.

Conclusion

The overall rate of undertriage (10.8%) was mainly influenced by a high rate of undertriage in the group of patients with only a positive mechanism criterion, therefore showing low diagnostic accuracy in selecting severely injured patients. As a consequence these patients with severe injury are undetected using the current triage protocol. As it has been shown that severely injured patients have better outcome in level one trauma care centres further optimisation of this protocol aiming at lowering undertriage is therefore essential, preferably without incrementing overtriage too much.     

Is endemic political corruption hampering provision of ART and PMTCT in developing countries?

Introduction

Leadership is a key factor in the success of HIV prevention and treatment. Positive HIV-related outcomes are also affected by funding levels for HIV, health sector resources, disease burden and the socio-economic environment. Leadership on HIV as well as these other factors are affected by the quality of political governance of the country, which may be an overarching factor that influences the making of effective responses to the HIV epidemic.

Aim

The aim of the study was to investigate the association between quality of political governance, on one hand, and coverage of antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT), on the other, in low- to middle-income countries.

Methods

This investigation was carried out through a global review, online data sourcing and statistical analyses. We collected data on health burden and resources, the socio-economic environment, HIV prevalence, ART and PMTCT coverage and indicators of political governance. Outcome variables were coverage of ART (from 2004) and PMTCT (from 2007) to 2009 as a percentage of persons needing it. Potential predictors of treatment coverage were fitted with a baseline multilevel model for univariable and multivariable analyses.

Results

Countries with higher levels of political voice and accountability, more political stability and better control of corruption have higher levels of ART coverage but not PMTCT coverage. Control of corruption (in standard deviation units) had a strong association with ART (AOR=1.82, p=0.002) and PMTCT (AOR=1.97, p=0.01) coverage. Indicators of economic development were not significant when control of corruption was included in the multivariable regression model. Many countries in all income groups had high ART but not PMTCT coverage (e.g. Mexico, Brazil and Romania in the upper-middle-income group; Papua New Guinea and Philippines in the lower-middle-income group; and Cambodia, Laos and Comoros in the low-income group). Very few low-income countries (notably, Haiti and Kenya) had high PMTCT coverage.

Conclusions

Our research found a significant relationship between quality of political governance and treatment coverage. Measures and policies for improving the quality of political governance should be considered as a part of HIV programme implementation to more effectively improve the welfare of people living with HIV, particularly mothers living with HIV and their babies.     

Landing on Your Own Two Feet: A Case Report of Bilateral Calcaneus and Open Pilon Fractures

High energy fractures of the distal tibial plafond and calcaneus have been associated with high functional morbidity and wound complications. Although both of these fractures result from a similar mechanism, they have rarely been reported to occur on an ipsilateral extremity. The combination of these 2 injuries on the same extremity would increase the likelihood of an adverse surgical or functional outcome. We present the case and management strategy of a 43-year-old male with bilateral open pilon fractures and closed calcaneal fractures after falling from a height. A staged protocol was used for the bilateral pilon fractures, with external fixation until operative fixation on day 9. Nonoperative management of the calcaneal fractures resulted in a successful functional outcome at 10 months of follow-up. Treatment of this fracture pattern must incorporate the condition of the soft tissues, an understanding of the fractures, and minimize patient risk factors to optimize the functional and surgical outcomes.     

Optimization of screw fixation in rat bone with extracorporeal shock waves

Screw fixation in osteoporotic patients is becoming an increasing problem in orthopaedic surgery as deterioration of cortical and cancellous bone hamper biomechanical stability and screw fixation. This might result in delayed weight‐bearing or failure of instrumentation. We hypothesized that local peri‐operative shock wave treatment can optimize osseointegration and subsequent screw fixation. In eight female Wistar rats, two cancellous and two cortical bone screws were implanted in both femora and tibiae. Immediately after implantation, 3.000 unfocused extracorporeal shock waves (energy flux density 0.3 mJ/mm²) were applied to one side. The other side served as non‐treated internal control. Evaluation of osseointegration was performed after 4 weeks with the use of microCT scanning, histology with fluorochrome labeling, and pull‐out tests of the screws. Four weeks after extracorporeal shock wave treatment, treated legs exhibited increased bone formation and screw fixation around cortical screws as compared to the control legs. This was corroborated by an increased pull‐out of the shock wave treated cortical screws. The cancellous bone screws appeared not to be sensitive for shock wave treatment. Formation of neocortices after shock wave therapy was observed in three of eight animals. Furthermore, de novo bone formation in the bone marrow was observed in some animals. The current study showed bone formation and improved screw fixation as a result of shock wave therapy. New bone was also formed at locations remote from the screws, hence, not contributing to screw fixation. Further, research is warranted to make shock wave therapy tailor‐made for fracture fixation. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:76–84, 2018.