Urbanization of black South African women may increase risk of low bone mass due to low vitamin D status, low calcium intake, and high bone turnover

Globally, rural to urban migration is accompanied by changes in dietary patterns and lifestyle that have serious health implications, including development of low bone mass. We hypothesized that serum 25 (OH) vitamin D3 (25[OH]D3) levels will be lower, bone turnover higher, and nutrition inadequate in urban postmenopausal black women, increasing risk for low bone mass. We aimed to assess the prevalence of risk factors for low bone mass in 1261 black women from rural and urban areas in the North West Province of South Africa (Prospective Urban and Rural Epidemiology-South Africa project). Fasting blood samples were taken; and participants were interviewed to complete questionnaires on self-reported diseases, fractures, and dietary intakes. Bone health markers were assessed in a subgroup of 658 women older than 45 years. Specific lifestyle risk factors identified were inactivity, smoking, injectable progestin contraception use, and high alcohol consumption. Dietary risk factors identified were low calcium and high animal protein, phosphorous, and sodium intakes. The 25(OH)D3 and C-terminal telopeptide (CTX) levels were significantly higher in the rural vs the urban women older than 50 years. Parathyroid hormone (PTH) levels increased with age in both groups. The 25(OH)D levels were inversely correlated with CTX and PTH in rural women. In urban women, PTH and CTX were correlated while dietary calcium was inversely correlated with CTX and PTH with 25(OH)D3. The combination of low dietary calcium (<230 mg/d), marginally insufficient 25(OH)D3 status, and raised PTH may result in increased bone resorption. Further research is required to assess bone health and fracture risk in black African women.     

山药苡仁健脾粉及其拆方的药理作用研究

目的:研究山药苡仁健脾粉及其拆方的药理作用。方法:通过环磷酰胺抑制免疫和碳廓清实验,观察山药苡仁健脾粉及其拆方对小鼠免疫调节功能的影响;采用小肠推进实验评价山药苡仁健脾粉及其拆方对肠蠕动的影响;采用转棒实验观察山药苡仁健脾粉及其拆方的抗疲劳功能;采用四氧嘧啶复制高血糖模型,观察山药苡仁健脾粉及其拆方对模型小鼠高血糖的影响。结果:山药粉、薏苡仁粉与山药苡仁健脾粉均能有效提高小鼠的免疫力,增加碳廓清率,对抗环磷酰胺所致的白细胞数量的减少,均有明显的抗疲劳作用;山药粉和山药苡仁健脾粉能促进小肠蠕动和有明显的降血糖作用,而薏苡仁粉作用不显著。结论:山药苡仁健脾粉具有促进肠蠕动、免疫调节、抗疲劳和降糖等保健功能,具有进一步开发的价值。     

Improvement of bone formation biomarkers after 1-year consumption with milk fortified with eicosapentaenoic acid,docosahexaenoic acid,oleic acid,and selected vitamins

The hypothesis of this study was that the replacement of regular milk with fortified milk in hyperlipidemic adults for 1 year would improve bone biomarkers. The fortified milk contained eicosapentaenoic acid and docosahexaenoic acid from fish oils, oleic acid, vitamins A, B₆, and E, as well as folic acid. We believe that the fortified milk will improve the blood fatty acid profile and vitamin status in subjects to benefit bone health biomarkers. From the 84 patients who accepted to participate, 11 of these were excluded for the presence of metabolic diseases and 1 was excluded for noncompliance with the protocol. Seventy-two hyperlipidemic patients (35-65 years) were randomly divided between 2 study groups. The supplement group (E; n = 39) consumed 0.5 L/d of fortified milk that contained fish oil, oleic acid, and vitamins. The control group (C; n = 33) consumed 0.5 L/d of semiskimmed milk containing the same amount of total fat. Blood samples were taken at T₀, T₃, T₆, and T₁₂ months to determine plasma fatty acids, vitamins B₆, E, and 25-hydroxyvitamin D and serum folate, calcium, soluble osteoprotegerin (OPG), soluble receptor activator of NF-κB ligand (RANKL), osteocalcin, parathormone, type I collagen carboxy-terminal telopeptide, and malondialdehyde. After 1 year, the E group showed a significant increase in plasma eicosapentaenoic acid (42%), docosahexaenoic acid (60%), vitamin B6 (38%), OPG (18%), RANKL (7%), OPG/RANKL (10%), red blood cell folate (21%), serum folate (53%), calcium (4%), vitamin D (11%), and osteocalcin (22%). Dietary supplementation with the fortified milk drink improved nutritional status and bone formation markers in adult hyperlipidemic patients.     

Serum Biomarkers Related to Glucocorticoid‐Induced Osteonecrosis of the Femoral Head: A Prospective Nested Case‐Control Study

Early diagnosis and prevention of glucocorticoid (GC)‐induced osteonecrosis of the femoral head (ONFH) continues to be a challenging problem for clinicians and researchers. However, the role of circulating biomarkers for GC‐induced ONFH, which may reveal individual susceptibility and facilitate earlier diagnosis, remains to be determined. The aim of this study was to identify potential biomarkers that may predict early GC‐induced ONFH. A total of 123 patients scheduled for initial systemic GC therapy were enrolled in this prospective nested case–control study. The serum concentrations of 13 potential biomarkers were measured in seven patients with GC‐induced ONFH, diagnosed instantly after short‐term use of GCs and in 20 controls who did not develop osteonecrosis despite similar GC therapy. Biomarkers were measured both before and after taking GCs to identify any differences in marker levels and the changes during GC therapy between two groups. Type I collagen cross‐linked C‐telopeptide (β‐CTX; p = 0.000) was significantly lower, high‐density lipoprotein cholesterol (p = 0.092) and apolipoprotein (apo)‐B/apo‐A1 (p = 0.085) tended to be lower and higher, respectively, before GC treatment in osteonecrosis group. After GC therapy, β‐CTX (p = 0.014) was significantly lower and amino terminal telopeptide of procollagen type I (PINP; p = 0.068) tended to be lower in the osteonecrosis group. As secondary outcomes, we observed remarkable changes in nine potential biomarkers following short‐term GC therapy in both groups. In conclusion, we found that β‐CTX, could potentially be used to predict GC‐induced ONFH before GC therapy. Lower β‐CTX and PINP are promising biomarkers for the early diagnosis of GC‐induced ONFH. These findings need to be confirmed in large‐scale prospective studies. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2348–2357, 2019     

Cholera: an overview with reference to the Yemen epidemic

Cholera is a secretory diarrhoeal disease caused by infection with Vibrio cholerae, primarily the V. cholerae O1 El Tor biotype. There are approximately 2.9 million cases in 69 endemic countries annually, resulting in 95 000 deaths. Cholera is associated with poor infrastructure and lack of access to sanitation and clean drinking water. The current cholera epidemic in Yemen, linked to spread of V. cholerae O1 (Ogawa serotype), is associated with the ongoing war. This has devastated infrastructure and health services. The World Health Organization had estimated that 172 286 suspected cases arose between 27th April and 19th June 2017, including 1170 deaths. While there are three oral cholera vaccines prequalified by the World Health Organization, there are issues surrounding vaccination campaigns in conflict situations, exacerbated by external factors such as a global vaccine shortage. Major movements of people complicates surveillance and administration of double doses of vaccines. Cholera therapy mainly depends on rehydration, with use of antibiotics in more severe infections. Concerns have arisen about the rise of antibiotic resistance in cholera, due to mobile genetic elements. In this review, we give an overview of cholera epidemiology, virulence, antibiotic resistance, therapy and vaccines, in the light of the ongoing epidemic in Yemen.     

Updated recommendations for managing the care of patients receiving oral bisphosphonate therapy: An advisory statement from the American Dental Association Council on Scientific Affairs

Background and OverviewIn 2005, the American Dental Association (ADA) Council on Scientific Affairs convened an expert panel to develop clinical recommendations for dentists treating patients who are receiving oral bisphosphonate therapy. The Journal of the American Dental Association published the resulting report in 2006. This 2008 advisory statement is the first of projected periodic updates of the 2006 clinical recommendations.ConclusionThis 2008 advisory statement concludes, on the basis of a review of the current literature, that for patients receiving bisphosphonate therapy, the risk of developing bisphosphonate-associated osteonecrosis (BON) of the jaw apparently remains low. It also newly concludes that current screening and diagnostic tests are unreliable for predicting a patient's risk of developing the condition. This statement updates the 2006 recommendations regarding general dentistry, management of periodontal diseases, implant placement and maintenance, oral and maxillofacial surgery, endodontics, restorative dentistry and prosthodontics, and orthodontics.     

Cerebrotendinous Xanthomatosis: Molecular Pathogenesis,Clinical Spectrum,Diagnosis, and Disease-Modifying Treatments

Cerebrotendinous xanthomatosis (CTX) is an autosomal recessive lipid storage disorder caused by mutations in the CYP27A1 gene, which encodes the mitochondrial enzyme sterol 27-hydroxylase. Decreased sterol 27-hydroxylase activity results in impaired bile acid synthesis, leading to reduced production of bile acids, especially chenodeoxycholic acid (CDCA), as well as elevated serum cholestanol and urine bile alcohols. The accumulation of cholestanol and cholesterol mainly in the brain, lenses, and tendons results in the characteristic clinical manifestations of CTX. Clinical presentation is characterized by systemic symptoms including neonatal jaundice or cholestasis, refractory diarrhea, juvenile cataracts, tendon xanthomas, osteoporosis, coronary heart disease, and a broad range of neuropsychiatric manifestations. The combinations of symptoms vary from patient to patient and the presenting symptoms, especially in the early disease phase, may be nonspecific, which leads to a substantial diagnostic delay or underdiagnosis. Replacement of CDCA has been approved as a first-line treatment for CTX, and can lead to biochemical and clinical improvements. However, the effect of CDCA treatment is limited once significant neuropsychiatric manifestations are established. The age at diagnosis and initiation of CDCA treatment correlate with the prognosis of patients with CTX. Therefore, early diagnosis and subsequent treatment initiation are essential.     

有机锗（Ge—132）增强环磷酰胺抗瘤作用的实验研究

本文观察了有机锗在试验治疗荷移植肝癌小鼠中增强血清超氧化物歧化酶活性及细胞免疫的作用，增强环磷酰胺抗移植肝癌作用以及它本身抗移植肝癌的效果，结果是：高剂量Ｇｅ－１３２（１２．５ｍｇ／次）治疗组的抑癌率为３１％，移植肝癌ＷＢＣ浸润者为７２．７％，血清ＳＯＤ活性分别是３６．４％，８１Ｎｕ／ｍｌ，两组比较差异显著（Ｐ〈０．０５），ＣＴＸ组的抑癌率是３７％，癌体ＷＢＣ浸润者为２７．３％，血清ＳＯＤ活性为１     

Therapeutic effects of total coumarins from Urtica dentata Hand on collagen-induced arthritis in Balb/c mice

Ethnopharmacological relevance

Urtica dentata Hand (UDH), the root of Laportea bulbifera (Sieb. et. Zucc.) Wedd, has long been utilized in traditional Chinese medicine for the treatment of rheumatoid arthritis and some other autoimmune diseases. Coumarins are the main active principles contributing to UDH's efficacy, but the mechanisms have not been fully clarified.

Aim of study

To explore effects of total coumarins (TC) isolated from UDH on the development of type II collagen (CII)-induced arthritis (CIA) in Balb/c mice.

Materials and methods

Arthritis was induced in Balb/c mice by immunization with an emulsion of 200 mg CII and complete Freund's adjuvant (CFA). The CIA mice were then given with a suspension of TC or saline by intragastric (i.g.) administration every other day. The incidence and severity of disease and histopathology of inflammation were assessed. Inflammatory response was determined by measuring the levels of different inflammation mediators in serum. The effect of TC on differentiation of CD4⁺CD25⁺ Foxp3⁺Treg cells was examined by flow cytometry. The phenotype of bone marrow-derived dendritic cells (DCs), T-bet mRNA level and IL-12p70 secretion by DCs were also detected.

Results

Pharmacologically, treatment with TC for type II collagen induced arthritis in mice through oral administration displayed significant and dose-dependent drop of clinical arthritis score and paw swelling, compared with the untreated CIA mice. Pathologic changes showed that TC protected tissues against bone destruction, whereas an almost complete destruction occurred in the CIA model group. The protective status was associated with a substantial decrease in the production of IFN-γ and IL-2, an increase of IL-10 and TGF-β and suppressive expression of T-bet in DCs. TC also induced the generation of CD4⁺CD25⁺ Treg cells with a Treg phenotype Foxp3. TC-treated DCs were characterized as low expression of MHC class II and CD86 molecules, as well as a reduction of IL-12p70.

Conclusions

Our data suggest that TC provides substantial therapeutic protection against CIA by eliciting immune tolerance and it would be a valuable candidate for further investigation as a new anti-arthritic agent.     

环磷酰胺冲击治疗难治性肾病综合征34例护理体会

目的:探讨环磷酰胺(CTX)冲击治疗难治性肾病综合征(RNS)的疗效及护理方法.方法:将68例RNS患者随机分为治疗组与对照组各34例,对照组采用强的松、洛汀新、潘生丁等治疗,治疗组在以上治疗的基础上加用CTX冲击治疗,并在治疗的前、中、后期实施不同的护理干预.结果:治疗组总有效率为85.29%,对照组为58.82%;治疗组1年内复发率为24.14%,时照组为65.00%.两组比较均有极显著性差异(P＜0.01).结论:CTX冲击治疗RNS效果满意,在冲击治疗的各个时期分别实施不同的护理干预,有助于减轻CTX冲击治疗的副作用,提高疗效,降低RNS复发率.