Influence of botulinum toxin site of injections on healing rate in patients with chronic anal fissure

BACKGROUND: Botulinum toxin induces healing in patients with idiopathic anal fissure. METHODS: Fifty patients affected by posterior anal fissure were treated with 20 units of botulinum toxin, injection in the internal anal sphincter on each side of the posterior midline (group I) or on each side of the anterior midline (group II). RESULTS: At 2 months evaluation, a healing scar was observed in 15 patients of group I and in 22 patients of group II(P = 0.025). Resting anal pressure was significantly different from the baseline values at 1-month as well as at 2-month check-ups in both groups, but the values were significantly lower in patients of group II. CONCLUSIONS: The intersite comparison revealed that anterior injection of the internal anal sphincter resulted in improved lowering of resting anal pressure and produced an earlier healing scar.     

Expression of hepcidin is down-regulated in TfR2 mutant mice manifesting a phenotype of hereditary hemochromatosis

Transferrin receptor 2 (TfR2) is a membrane glycoprotein that mediates cellular iron uptake from holotransferrin. Homozygous mutations of this gene cause one form of hereditary hemochromatosis in humans. We recently reported that homozygous TfR2(Y245X) mutant mice, which correspond to the TfR2(Y250X) mutation in humans, showed a phenotype similar to hereditary hemochromatosis. In this study, we further analyzed the phenotype as well as iron-related gene expression in these mice by comparing the TfR2-mutant and wild-type siblings. Northern blot analyses showed that the levels of expression of hepcidin mRNA in the liver were generally lower, whereas those of duodenal DMT1, the main transporter for uptake of dietary iron, were higher in the TfR2-mutant mice as compared to the wild-type siblings. Expression of hepcidin mRNA in the TfR2 mutant mice remained low even after intraperitoneal iron loading. In isolated hepatocytes from both wild-type and TfR2 mutant mice, interleukin-6 and lipopolysaccharide each induced expression of hepcidin mRNA. These results suggest that up-regulation of hepcidin expression by inflammatory stimuli is independent of TfR2 and that TfR2 is upstream of hepcidin in the regulatory pathway of body iron homeostasis.     

Pedestrian Injuries and the Relevant Burden in Shanghai,China:Implications for Control

Objective To study the associations of pedestrian injuries with age, income and educational level in Shanghai and to analyze the relative disease burden. Methods Information on pedestrian-related cases and deaths were collected from 494 hospitals and mortality registry systems from 1992 to 2010, and a multistage cluster sampling survey conducted in 2006. Logistic regression model was used in the analyses. Results The age group of 5-9 had the highest mortality and morbidity among children. Mortality increased obviously among those aged 60 or above. Individuals with an educational level under the primary school and with the lower family average income were more likely to suffer pedestrian-related injuries. Multivariate Logistic analysis demonstrated that lower income and lower educational level increased the risk of pedestrian injuries with the odds ratio of 1.40 (95%CI:1.15-1.71) and 1.70 (95%CI:1.20-2-40), respectively. About 13.54% of the share of GDP for the healthcare, social security and welfare industries in Shanghai was occupied by the burden of pedestrian-related injuries in 2006. Conclusion Pedestrian-related injury has inverse association with victims’ income and educational level. Children of 5-9 years old and adults over 60 with lower educational level and lower monthly income are the target persons to be intervened.     

The MICA Case Conference Program at Tewksbury Hospital, Mass.: an integrated treatment model

This report describes the MICA (Mentally Ill Chemically Abusing) Program at the Tewksbury Hospital campus in Tewksbury, Massachusetts. Several campus facilities collaborate in the MICA Program. Through Expert Case Conferences, principles of integrated psychosocial treatment with dual diagnosis patients are demonstrated. An expert clinician focuses on the interplay between psychological pain, characterological traits, defenses, and the patient's drug of choice. Patients who have participated in the program have reported positive experiences. The staff reported that the program has resulted in facility improvement in assessment and treatment of complex dual diagnosis patients.     

Association of Hepatitis A Exposure and TIM-1 with Childhood Allergic Asthma

Background. Hepatitis A virus (HAV) receptor (TIM-1) polymorphism plays an important role in asthma and autoimmune diseases. Objective. To analyze the association of TIM-1 polymorphism and HAV infection with childhood allergic asthma in Southwest China. Methods. TIM-1 exon 4 (157insMTTTVP) and two polymorphism loci, -416G>C and -1454G>A, in the HAV receptor promoter region were studied. Polymerase chain reaction (PCR) was used to test the genotypes of three polymorphism loci among 579 cases of asthma and 524 controls. The HAV infection status was determined in a case-control study with stratified analysis. Results. HAV exposure associated with childhood allergic asthma in the study population was compared with controls (odds ratio (OR) = 0.181, 95% confidence interval (CI) 0.126-0.260, p < .001). The -416G>C polymorphism was associated with asthma (OR = 1.384, 95% CI 1.148-1.669, p < .001), but the insertion variant 157delMTTTVP of exon 4 and the -1454G>A polymorphism were not. Conclusion. Our results indicated that the -416G>C polymorphism of the TIM-1 gene is associated with childhood allergic asthma, providing a better understanding of the pathogenesis of the allergic asthma among children aged below 15 years in Southwest China.     

髓母细胞瘤伴广泛结节及神经元分化型一例

患儿男,1岁8个月。主因走路不稳22d,加重伴呕吐10d于2004年9月17日入院。患儿于入院前22d,家人发现其走路不稳,易跌倒,渐加重伴恶心、呕吐。头颅MRI检查：左小脑蚓部占位性病变,呈多结节状,部分区域囊性变伴脑积水（图1）。个人史、家族史均无特殊。[第一段]     

Atorvastatin inhibits myocardin expression in vascular smooth muscle cells

Atorvastatin (ATV), an inhibitor of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, is widely prescribed as a lipid-lowering drug. It also inhibits the RhoA-Rho-associated kinase pathway in vascular smooth muscle (SM) cells and critically inhibits SM function. Myocardin is a coactivator of serum response factor, which upregulates SM contractile proteins. The RhoA-Rho-associated kinase pathway, which directly triggers SM contraction, also increases myocardin gene expression. Therefore, we investigated whether ATV inhibits myocardin gene expression in SM cells. In mice injected with ATV (IP 20 μg/g per day) for 5 days, myocardin gene expression was significantly downregulated in aortic and carotid arterial tissues with decreased expression of myocardin target genes SM α-actin and SM22. Correspondingly, the contractility of aortic rings in mice treated with ATV or the Rho-associated kinase inhibitor Y-27632 was reduced in response to treatment with either KCl or phenylephrine. In cultured mouse and human aortic SM cells, KCl treatment stimulated the expression of myocardin, SM α-actin, and SM22. These stimulatory effects were prevented by ATV treatment. ATV-induced inhibition of myocardin expression was prevented by pretreatment with either mevalonate or geranylgeranylpyrophosphate but not farnesylpyrophosphate. Treatment with Y-27632 mimicked ATV effects on the gene expression of myocardin, SM α-actin, and SM22, further suggesting a role for the RhoA-Rho-associated kinase pathway in ATV effects. Furthermore, ATV treatment inhibited RhoA membrane translocation and activation; these effects were prevented by pretreatment with mevalonate. We conclude that ATV inhibits myocardin gene expression in vivo and in vitro, suggesting a novel mechanism for ATV inhibition of vascular contraction.     

关节镜下行(足母)外翻外侧松解背侧入路的研究

目的探讨关节镜下行躅外翻外侧松解背侧入路的可行性及方法。方法解剖研究采用10具新鲜保留踝关节的足部标本。在关节镜监视下,以钩刀松解外侧关节囊和躅内收肌斜头。观察各入路与周围神经血管、肌腱之间的关系,并统计松解范围。临床研究对5例躅外翻患者行关节镜下外侧松解加内侧软组织紧缩手术,患者均为女性,平均年龄30岁。术前躅外翻角为24^o-38^o,平均30^o,跖间角为9^o-11^o,平均10^o。结果解剖研究近侧切口与躅短伸肌腱非常接近,为0—3mm,平均1．5mm;与躅长伸肌腱相距为1—4mm,平均2．4mm。远侧切口与第一趾背动脉和趾背神经非常接近,为1～3mm,平均1、4mm,极易损伤。6例正常足中,1例松解跖籽骨韧带,1例作部分松解（70％）。在4例足母外翻足中,2例松解跖籽骨韧带,1例作了部分松解（50％）。临床研究5例患者平均随访时间9个月。最后一次随访时X线片示足母外翻角4^o-9^o,平均7^o,跖间角8^o～10^o,平均9^o。患者均恢复良好,对外形满意,未见肌腱损伤、麻木、感染、跖趾关节僵硬等并发症发生。结论背侧入路关节镜下外侧松解是可行的,其手术切口较小,镜下视野清晰,可以根据需要松解外侧结构的各个部分,由于不损伤血管,减少了跖骨头坏死的发生。