Can Primary Care for Back and/or Neck Pain in the Netherlands Benefit From Stratification for Risk Groups According to the STarT Back Tool Classification?

Objective

To evaluate whether current Dutch primary care clinicians offer tailored treatment to patients with low back pain (LBP) or neck pain (NP) according to their risk stratification, based on the Keele STarT (Subgroup Targeted Treatment) Back-Screening Tool (SBT).

“施氏十二字养生功”防治颈椎病技术推广临床研究

目的:通过系统研究,证实施氏十二字养生功在颈椎病防治中的重要意义;同时加深中医导引理论的理解,为社区推广提供完整的技术资料及推广方案。方法:为多中心临床研究,5家合作单位,每家25例,共125例患者,采用施氏十二字养生功干预治疗,以上课的方式每周由各临床分中心的课题负责人以带教的方式举行一次培训,共持续12周,每次持续时间40min左右。除培训外,整个干预过程,要求患者按照发给他们的施氏十二字养生功DVD光盘在家中练习,每天至少练习20min,直到24周随访。应用VAS疼痛评估和NDI评估综合评价治疗前后患者疼痛改善情况和颈部功能改善情况。结果:在疼痛改善和NDI评分方面,治疗12周与治疗前相比VAS和NDI评分均有显著降低(P0.01);在24周随访与治疗12周相比,VAS和NDI评分仍有显著下降(P0.01)。结论:施氏十二字养生功治疗后可以明显缓解疼痛、减轻颈项部症状、提高患者的生活质量。     

Delayed Mitogenic Stimulation Decreases DNA Damage Assessed by Micronucleus Assay in Human Peripheral Blood Lymphocytes After 60Co Irradiation

While contradictory reports are available on the yield of dicentric chromosomes (DC) in blood samples stored at different temperature and stimulated to enter into cell cycle, various times gap followed by exposure, limited information is available on the micronucleus (MN) assay. As scoring the micronuclei frequency from the blood lymphocytes of exposed individuals is an alternative to the gold standard DC assay for triage applications, we examined radiation induced MN yield in delayed mitogenic stimulation after irradiation of in vitro. Peripheral blood lymphocytes (PBL) were exposed to low LET (⁶⁰Co) radiation dose (0.1 to 5Gy) and incubated at 37°C for 2, 6 and 24 hours. The MN frequency obtained in blood samples stimulated 2 hours post-irradiation showed a dose dependent increase and used to construct the dose-response curve. Further, the results also showed that blood samples stimulated twenty four hours of post-irradiation, a significant reduction (p<0.05) in MN frequencies were obtained when compared to that of blood samples stimulated two hours and six hours after post-irradiation (0.5, 1, 3 and 5Gy). The observed result suggests that the prolonged PBL storage without mitogenic stimulation could lead to interphase cell death and a delayed blood sampling could results in underestimation of dose in biological dosimetry.     

Association of Skipping Breakfast With Cardiovascular and All-Cause Mortality

Background

Skipping breakfast is common among U.S. adults. Limited evidence suggests that skipping breakfast is associated with atherosclerosis and cardiovascular disease.

Repulsion between Lys258 and upstream arginines explains the missorting of the AQP2 mutant p.Glu258Lys in nephrogenic diabetes insipidus

Regulation of body water homeostasis occurs by the vasopressin‐dependent sorting of aquaporin‐2 (AQP2) water channels to and from the apical membrane of renal principal cells. Mutations in AQP2 cause autosomal nephrogenic diabetes insipidus (NDI), a disease that renders the kidney unresponsive to vasopressin, resulting in polyuria and polydipsia. The AQP2 mutant c.772G>A; p.Glu258Lys (AQP2–E258K) causes dominant NDI by oligomerizing with wild‐type AQP2 and missorting of this AQP2 complex to multivesicular bodies instead of the apical membrane. The motif causing this missorting of AQP2–E258K was identified here. Functional analyses and plasma membrane expression studies of truncation mutants in oocytes revealed that AQP2–E258K shortened to Leu259 is still intracellular retained. Alanine scanning and glutamic acid to arginine exchanges revealed increased function and plasma membrane expression for AQP2–E258K mutants with the following additional changes: Leu259Ala, Arg252Glu, Arg253Glu, or Arg252Ala–Arg254Ala, or for the AQP2 mutant p.Glu258Ala, indicating that the motif RRRxxxK₂₅₈L confers AQP2–E258K retention. Fusion of this motif to aquaporin‐1 also resulted in missorting of that water channel, indicating that this retention motif is transferable. In conclusion, our data reveal that the RRRxxxKL motif and repulsion between K258 and the arginine‐triplet within this motif are the primary cause of missorting of AQP2–E258K in NDI. Hum Mutat 30:1–10, 2009. © 2009 Wiley‐Liss, Inc.     

Rapid differential diagnosis of diabetes insipidus in a 7-month-old infant: The copeptin approach

Introduction

Diabetes insipidus is characterized by hypoosmotic polyuria related to deficiency of arginine–vasopressin (AVP) secretion (central diabetes insipidus, CDI) or renal insensitivity to AVP (nephrogenic diabetes insipidus, NDI). The water deprivation test with assessment of AVP activity is currently the gold standard for differential diagnosis in patients presenting polyuria–polydipsia syndrome. Nevertheless, it can be dangerous without proper surveillance and its interpretation may be challenging. Other markers have been suggested. Direct quantification of circulating AVP is not sufficient for diagnosis: vasopressin is unstable, analysis is complex. AVP comes from prohormone preprovasopressin with concomitant release of copeptin (C-terminal moiety) in the equimolar ratio. Copeptin is stable in vitro, with easy and rapid measurement (< 4 h). Past studies have shown greater sensitivity and specificity of copeptin versus AVP to discriminate etiologies of polyuria in adults, but its value has not been demonstrated in infants yet.

针刺足阳明胃经特定穴对功能性消化不良的作用

目的:观察针刺足阳明经特定穴对功能性消化不良(FD)患者的临床疗效和对生活质量的影响。方法:60例FD患者随机分为2组各30例。针刺组针刺足阳明经特定穴,对照组针刺非经非穴,均每日1次。分别于治疗前后填写尼平消化不良指数(NDI),包括症状和生活质量指数(NDSI、NDLQI)、健康相关生活质量评分(SF-36)。结果:治疗20次后,2组SF-36及NDLQI指数评分较治疗前显著增加,NDSI显著下降(P0.01);针刺组较对照组更明显(P0.01)。治疗后1个月随访,2组SF-36及NDLQI指数评分与治疗完成时略上升,NDSI评分仍有下降,但差异无统计学意义。结论:针刺足阳明经特定穴和非经非穴治疗FD均能改善患者的症状,但特定穴疗效更显著。     

A Novel Mutation of the Arginine Vasopressin Receptor 2 Gene in a Patient with Congenital Nephrogenic Diabetes Insipidus

We have identified a novel mutation of the arginine vasopressin receptor 2 (AVPR2) gene in a case of congenital X-linked nephrogenic diabetes insipidus (NDI). The patient was a 2-mo-old Japanese boy with persistent fever and failure to thrive. He was diagnosed as having congenital NDI by clinical and laboratory findings. Molecular analysis demonstrated that he was hemizygous for a G to C transversion in exon 2 of the AVPR2 gene which resulted in a glycine to arginine substitution (G107R) at the 107th codon of the first extracellular loop. His mother was heterozygous for the same mutation. We speculated that the G107R mutation would interfere with the binding capacity of the AVPR2, since G107R is located near F105 and R106, both of which are crucial for ligand binding. In cases of X-linked NDI, mutations in the AVPR2 gene are distributed widely. Thus, DNA analysis throughout the gene is of clinical value for the identification of female carriers, and it also gives precise information for genetic counseling.     

Lack of oral embryotoxicity/teratogenicity with D-ribose in Wistar rats.

The present oral embryotoxicity/teratogenicity study of d-Ribose (DR) was conducted in female rats; 28 rats/group were exposed via the diet to 0, 5, 10, or 20% DR (0.0, 4.25, 7.94, 9.91g/kg body weight/day), from day 0 of gestation until Caesarian section and maternal sacrifice on day 21. All animals survived to the end of the study. Fecundity index, gestation index, pre-implantation loss, post-implantation loss, and sex ratio were all unaffected by treatment with DR. External observations of fetuses and placentas were unremarkable across the study groups. Mean fetal and placental weights, across all viable fetuses, did not differ significantly between treated and control groups. Observations of visceral malformations, anomalies, and variations were unremarkable and did not differ between treated and control groups. In summary, administration of DR to pregnant rats at concentrations up to 20% of the diet resulted in no significant adverse effects on the developing embryo/fetus at doses that were not otherwise a severe metabolic stress on the dam. A No Observed Adverse Effect Level (NOAEL) for teratogenicity could be seen at a concentration of 5% DR in the diet, corresponding to an average daily intake of DR of between 3.64 and 4.61g/kg body weight/day.