Elevated serum complement C3 levels are related to the development of prediabetes in an adult population: the Tianjin Chronic Low-Grade Systematic Inflammation and Health Cohort Study

AIMS

To investigate whether serum complement C3 is related to the prevalence and incidence of prediabetes in an adult population.

METHODS

A cross-sectional (n = 10 206) and prospective cohort study (n = 3333), with a mean (range; 95% CI) follow-up of 2.63 (1-6; 2.58-2.68) years, was conducted in people recruited from the Health Management Centre of Tianjin Medical University General Hospital in Tianjin, China. Measurement of serum C3 concentration, blood fasting glucose, oral glucose tolerance, HbA1c and other potential confounding factors was performed at baseline and each year during the follow-up. Prediabetes was defined according to the criteria of the American Diabetes Association. Adjusted logistic and Cox proportional hazards regression models were used to assess the relationships between C3 quintiles and prediabetes.

RESULTS

The prevalence and incidence of prediabetes were 38.5% and 119 per 1000 person-years, respectively. In cross-sectional analysis, after adjustment for potential confounders, the odds ratios of prediabetes for increasing quintiles of C3 were 1.00 (reference), 1.32 (95% CI 1.14-1.53), 1.37 (95% CI 1.18-1.59), 1.75 (95% CI 1.51-2.03), 2.25 (95% CI 1.93-2.62; P for trend < 0.0001). In the cohort analysis, the multiple-adjusted hazard ratio of prediabetes in the highest quintile of baseline C3 was 1.43 (95% CI 1.15, 1.78; P for trend < 0.001), when compared with the lowest quintile.

CONCLUSIONS

These findings indicate that elevated serum C3 levels are significantly related to an increased risk of developing prediabetes in an adult population, suggesting that C3 can be used as a biomarker in high-risk individuals to improve primary prevention of prediabetes and diabetes.

Abscess formation in ovarian endometriomas after failure of mifepristone-induced abortion

OBJECTIVE

To report a case of abscess formation in bilateral ovarian endometriomas after failure of mifepristone-induced abortion.

CASE REPORT

A-36-year-old multiparous woman with bilateral ovarian endometriomas conceived spontaneously and received mifepristone to induce an abortion at 35 days' gestation. Fever and lower abdominal pain occurred 28 days after the abortion. The patient then underwent surgical curettage for an incomplete abortion complicated by endometritis. Her symptoms and signs became aggravated, and computed tomography showed a large ovarian abscess. She underwent laparoscopic drainage of the abscess plus the enucleation of the ovarian endometriomas, and received intravenous antibiotic treatment. She resumed menstruation one month later and was doing well at the 11-month follow-up.

CONCLUSION

This case demonstrates the importance of combining antibiotic therapy with mifepristone to induce abortions in women with known ovarian endometriomas.

Association between five common polymorphisms in microRNA genes and the risk of gastric cancer: a meta-analysis

Gastric cancer (GC) is a prevalent disease with a high mortality rate, especially in developing countries. Accumulating evidence suggests that single nucleotide polymorphisms in microRNA (miRNA) genes might influence the susceptibility to GC; such sequence variation might contribute to the development of disease by altering crucial cellular pathways. In this study, we assessed the correlation between the miR-146a G>C, miR-196a-2 C>T, miR-499 T>C, miRNA-27a A>G, and miRNA-149 T>C polymorphisms and the susceptibility to GC. A comprehensive literature search for relevant studies published prior to August 2014 was conducted using PubMed/Medline, Embase, Web of Science, the Cochrane Library, and CNKI databases along with Google Scholar. Meta-analysis was performed using odds ratios (ORs) and 95% confidence intervals (CIs) as effect measures, incorporating 19 studies encompassing 8285 patients and 10,716 controls. Allelic, dominant, recessive, homozygous, and heterozygous genetic models were examined. Pooled results showed that none of the five polymorphisms studied were statistically related to GC. Stratified analyses by ethnicity and source of controls were conducted for miR- 146a G>C and miR-196a-2 C>T. Subgroup analysis suggested that the miR-146a G allele might increase the risk of GC in hospital-based case-control (HCC) but not in population-based case-control studies (HCC: recessive model: OR = 1.23, 95%CI = 1.10-1.37, P < 0.001; heterozygous model: OR = 1.19, 95%CI = 1.06-1.34, P = 0.004). Overall, this meta-analysis failed to detect an association between five common miR-146a gene polymorphisms and GC susceptibility. However, this does not necessarily completely rule out a correlation between miRNA polymorphisms and GC susceptibility.

The interaction of serum testosterone levels and androgen receptor CAG repeat polymorphism on the risk of erectile dysfunction in aging Taiwanese men

Testosterone has been found to play important roles in men's sexual function. However, the effects of testosterone can be modulated by androgen receptor (AR) CAG repeat polymorphism. It could also contribute to the risk of erectile dysfunction (ED). The aim of this study is to evaluate the interaction of serum testosterone levels and AR CAG repeat polymorphism on the risk of ED in aging Taiwanese men. This cross-sectional data of Taiwanese men older than 40 years were collected from a free health screening held between August 2010 and August 2011 in Kaohsiung city, Taiwan. All participants completed a health questionnaires included five-item version of the International Index of Erectile Function (IIEF-5) and the International Prostate Symptoms Score, received a detailed physical examination and provided 20 cm3 whole blood samples for biochemical and genetic evaluation. The IIEF-5 was used to evaluate ED. Serum albumin, total testosterone (TT), and sex hormone-binding globulin levels were measured. Free testosterone level was calculated. AR gene CAG repeat polymorphism was determined by direct sequencing. Finally, 478 men with the mean age of 55.7 ± 4.8 years were included. When TT levels were above 330 ng/dL, the effect of testosterone level on erectile function seemed to reach a plateau and a significantly negative correlation between AR CAG repeat length and the score of IIEF-5 was found (r = -0.119, p = 0.034). After adjusting for other covariates, the longer AR CAG repeat length was still an independent risk factor for ED in subjects with TT above 330 ng/dL (p = 0.006), but not in TT of 330 ng/dL or below. In conclusion, both serum testosterone levels and AR CAG repeat polymorphism can influence erectile function concomitantly. In subjects with normal TT concentration, those with longer AR CAG repeat lengths have a higher risk of developing ED.

The Donor Kidney Biopsy and Its Implications in Predicting Graft Outcomes: A Systematic Review

Despite a growing organ shortage in the United States, many deceased donor kidneys removed for transplantation are discarded. Kidney biopsy findings often play a role in these discards, although it is not clear whether biopsies reliably inform acceptance decisions. Therefore, we carried out a systematic review of the medical literature on the utility of both procurement and implantation biopsies for predicting posttransplant outcomes. Between January 1, 1994 and July 1, 2014, 47 studies were published in the English language literature that examined the association between pretransplant donor biopsy findings from 50 or more donors (with more than half being from deceased donors) and either posttransplant graft failure, delayed graft function, or graft function. In general, study quality was poor. All were retrospective or did not indicate if they were prospective. Results were heterogeneous, with authors as often as not concluding that biopsy results did not predict posttransplant outcomes. The percent glomerular sclerosis was most often examined, and failed to predict graft failure in 7 of 14 studies. Of 15 semiquantitative scoring systems proposed, none consistently predicted posttransplant outcomes across studies. Routine use of biopsies to help determine whether or not to transplant a kidney should be reexamined.

TRANSPLANTATION OF HYPERTHERMIC PRECONDITIONING OLFACTORY ENSHEATHING CELLS COMBINED WITH NEURAL STEM CELLS IN THE TREATMENT OF CENTRAL NERVE INJURY

This study aims to observe the effect of the transplantation of hyperthermic preconditioning (HPC) olfactory ensheathing cells (OECs) at 40°C combined with neural stem cells (NSCs) in the treatment of spinal cord injury (SCI), based on the OECs and NSCs taken from the olfactory bulbs and cerebral cortex of newborn rats. Forty-two female Sprague Dawley (SD) rats were randomly divided into: control group, NSCs+OECs without HPC group and NSCs+HPC OECs group. Firstly, hemisected spinal cord injury model was established; the motor function recovery of the right lower limb of the rats was compared by Basso-Beatie-Bresnahan rating (BBB rating), climbing score and running time on a rotating platform during the whole experiment. At one day, two weeks and four weeks after transplantation, two rats were randomly selected from each group for section preparation. Hematoxylin and eosin (HE) staining was performed on the sections to observe and analyze the pathological changes of the spinal cord tissue, and bromodeoxyuridine (BrdU) labeling was used to observe the distribution of transplanted cells. The results demonstrated that, BBB score of the rats that were treated by transplantation of NSCs combined with HPC OCEs was distinctly improved; a rapid increase of BBB score was found two weeks after transplantation, while BBB score had slightly increased six weeks later. BBB score of the control group and the NSCs+OECs without HPC group was found with a slight increase, especially in the control group. BBB score of NSCs+HPC OECs was significantly higher than in the control group and the NSCs+OECs without HPC group at the 2nd, 4th, 6th, 8th and 12th week after treatment (P<0.05). Climbing tests and detection of running time after 4 weeks and 6 weeks demonstrated that, the recovery of limb function of the NSCs+HPC OECs group was better than the other groups (P<0.05). HE staining results of NSCs+HPC OECs indicated that, cells of the spinal cord were neatly arranged, close to normal. BrdU labeling results revealed that, transplanted cells were found in injury tissue, indicating that they were involved in the spinal cord repair. This study proves that, the effect of NSCs combined with HPC OECs in the treatment of SCI is better than NSCs combined with OECs without HPC, and the ratio of NSCs differentiating to neuron after inducing HPC OECs supernate is higher than that after inducing OECs supernate without HPC.

Small-molecule inhibitors targeting the DNA-binding domain of STAT3 suppress tumor growth, metastasis and STAT3 target gene expression in vivo

Signal transducer and activator of transcription 3 (STAT3) is constitutively activated in malignant tumors and has important roles in multiple aspects of cancer aggressiveness. Thus targeting STAT3 promises to be an attractive strategy for treatment of advanced metastatic tumors. Although many STAT3 inhibitors targeting the SH2 domain have been reported, few have moved into clinical trials. Targeting the DNA-binding domain (DBD) of STAT3, however, has been avoided due to its 'undruggable' nature and potentially limited selectivity. In a previous study, we reported an improved in silico approach targeting the DBD of STAT3 that resulted in a small-molecule STAT3 inhibitor (inS3-54). Further studies, however, showed that inS3-54 has off-target effect although it is selective to STAT3 over STAT1. In this study, we describe an extensive structure and activity-guided hit optimization and mechanistic characterization effort, which led to identification of an improved lead compound (inS3-54A18) with increased specificity and pharmacological properties. InS3-54A18 not only binds directly to the DBD and inhibits the DNA-binding activity of STAT3 both in vitro and in situ but also effectively inhibits the constitutive and interleukin-6-stimulated expression of STAT3 downstream target genes. InS3-54A18 is completely soluble in an oral formulation and effectively inhibits lung xenograft tumor growth and metastasis with little adverse effect on animals. Thus inS3-54A18 may serve as a potential candidate for further development as anticancer therapeutics targeting the DBD of human STAT3 and DBD of transcription factors may not be 'undruggable' as previously thought.

The significance of the co-existence of osteopontin and tumor-associated macrophages in gastric cancer progression

Background

Osteopontin (OPN) can recruit macrophages to the site of inflammation and promote tumorigenesis. M2 tumor-associated macrophages (M2-TAMs) also play an important role in cancer progression. This study aimed to clarify the role of OPN and M2-TAMs co-existence in gastric cancer.

Methods

The levels of OPN and M2-TAMs were evaluated by immunohistochemical staining in 170 resected gastric cancer specimens that were collected from 1998 to 2012. M2-TAMs were identified by staining for an M2 marker, CD204. The prognostic significance and correlation between OPN and CD204 expression were analyzed. A co-culture system of OPN⁺-AGS and U937 cells was designed to study the effect of OPN on the skewing of macrophages toward M2-TAMs for gastric cancer progression in vitro and in vivo.

Results

Patients with high expression (>50%) of OPN or CD204 exhibited poor 5-year overall survival rates (48.61%, p = 0.0055, and 52.14%, p = 0.0498, respectively). A positive correlation was observed between OPN and CD204 expression and high co-expression of OPN and CD204 demonstrated poor 5-year overall survival rates (48.90%, p = 0.0131). In the co-culture study, OPN was able to attract U937 cells and skew them toward M2-TAMs through paracrine action. The M2-TAMs could increase the invasiveness of OPN⁺-AGS cells and the growth rate of xenograft of a mixture of co-cultured OPN⁺-AGS and U937 cells.

Conclusion

OPN can skew macrophages toward M2-TAMs during gastric cancer progression. The co-existence of OPN and infiltrating M2-TAMs correlates with disease progression and poor survival and thus can serve as a prognostic marker in gastric cancer.

TBX21 polymorphisms are associated with virus persistence in hepatitis C virus infection patients from a high-risk Chinese population

Hepatitis C virus (HCV) infection is a major cause of chronic liver disease and the varied outcomes of the infection depend on both viral and host factors. We have demonstrated that the HCV alternate reading frame protein (F protein) is related to Th1/Th2 bias which is involved in virus persistence in chronic hepatitis C (CHC) patients. The purpose of this study was to test the hypothesis that genetic variants of TBX21 (T cell specific T-box transcription factor) were associated with the outcomes of HCV infection and F protein generation. Three single nucleotide polymorphisms (SNPs) (rs17250932, rs2074190, rs4794067) in the TBX21 gene were genotyped in a case-control study in a cohort of a high-risk group, including 354 healthy controls and 747 CHC patients (190 anti-F protein antibody seronegative patients and 557 anti-F protein antibody seropositive patients). Results showed that the rs4794067 C allele in the TBX21 promoter was significantly more common in CHC patients (OR = 1.335, 95% CI = 1.058-1.684, P = 0.015), exceptionally in anti-F protein seropositive patients (OR = 1.547, 95% CI = 1.140-2.101, P = 0.005), compared with healthy controls. And the risk effect was also significantly high in patients with HCV 1b genotype and mild fibrosis (P = 0.021, P = 0.010, respectively). Compared with the most frequent haplotype TAT, haplotype analysis showed that the distribution of TAC was significantly different between the chronic HCV carrier group and the healthy group, and so was the anti-F antibody seronegativity group and the anti-F antibody seronegativity group (all P < 0.001). Our results suggested that TBX21 variants may be involved in the etiology of this disease.

Sonic hedgehog through Gli2 and Gli3 is required for the proper development of placental labyrinth

Sonic hedgehog (Shh) functions as a conserved morphogen in the development of various organs in metazoans ranging from Drosophila to humans. Here, we have investigated the potential roles and underlying mechanisms of Shh signaling in murine placentation. Immunostaining revealed the abundant expression of the main components of Shh pathway in both the trophectoderm of blastocysts and developing placentas. Disruption of Shh led to impaired vascularogenesis of yolk sac, less branching and malformation of placental labyrinth, thereby leading to a robust decrease in capacity of transplacental passages. Moreover, placenta-specific gene incorporation by lentiviral transduction of mouse blastocysts and blastocyst transplantation robustly knocked down the expression of Gli3 and Gli2 in placenta but not in embryos. Finally, Gli3 knockdown in Shh^−/− placentas partially rescued the defects of both yolk sac and placental labyrinth, and robustly restored the capacity of transplacental passages. Gli2 knockdown in Shh^+/− placentas affected neither the capacity of tranplacental passages nor the vascularogenesis of yolk sac, however, it partially phenocopied the labyrinthine defects of Shh^−/− placentas. Taken together, these results uncover that both Shh/Gli2 and Shh/Gli3 signals are required for proper development of murine placentas and are possibly essential for pregnant maintenance.

Single uroflow study as a tool in predicting the possibility of abnormal voiding symptoms after the administration of antimuscarinic agents in treating overactive bladder syndrome

PURPOSE OF STUDY

The aim of this study was to evaluate the efficacy of uroflowmetry in predicting the possibility of abnormal voiding symptoms following antimuscarinic treatment for overactive bladder syndrome (OAB) in Taiwanese women.

MATERIALS AND METHODS

A retrospective study was conducted on women with OAB. Forty-five women with abnormal voiding patterns shown by urodynamic study comprised the main group and 38 women with normal voiding patterns comprised the control group. All patients were prescribed two mg tolterodine once daily for one week. Follow-up on complaints of abnormal voiding symptoms was done one week later.

RESULTS

One woman in control group and 12 women in main group complained of abnormal voiding symptoms. There was a significant difference in the occurrence of abnormal voiding symptoms after antimuscarinic administration between main study group and control group (26.7 % vs 2.6 %, p = 0.02). CONCLUSIOn: Uroflowmetry is a non-invasive and simple tool to predict the occurrence of abnormal voiding symptoms after antimuscarinic use.

Hepatic stellate cells secretes type I collagen to trigger epithelial mesenchymal transition of hepatoma cells

Liver fibrosis is a risk factor for hepatoma. Activated hepatic stellate cells (HSCs) play a critical role in progression of hepatoma. Resected hepatoma patients with high α-SMA+HSCs infiltration had worse survival, OR: 2.2 and p=0.0434. We hypothesized that HSCs could increase the epithelial-mesenchymal transition (EMT) ability of hepatoma cells. In murine model of liver fibrosis with injection of ML1 mice HCC cell line, E-cadherin was lost at the margin of tumor nodule around α-SMA+HSC sites. In subcutaneous tumor model, HSCs could increase the metastatic nodules in the lung, and the expression of E-cadherin was decreased and the Slug was induced. To elucidate the effect of HSCs on hepatoma cells, HSC-T6 was co-cultured with ML1 and the condition medium of HSC-T6 can trigger ML1 cell morphological change, down-expression of E-cadherin, induction of Slug expression, and cell migration. Proteomic analysis of the condition medium showed that collagen I was the target molecule. Collagen type I alone also induced EMT of ML1 cells. Knockdown of collagen type I in HSC-T6 could decrease its induction of EMT on ML1 cells. In conclusion, HSC can secrete collagen type I to trigger hepatoma cells to undergo EMT for metastasis.

Mechanical endurance and in vivo radiographic analysis of a flexible, mono-unit cervical disc implant in intermediate follow-up period

AIM

The flexible artificial disc may create a system with a biomimetic structure that has the potential to tolerate dynamic motion in a way similar to a normal intervertebral disc over a long period. The objective was to evaluate the mechanical feasibility and clinical and radiological findings with a mono-unit and flexible artificial disc at intermediate-term follow-up.

METHODS

Fifty-six patients with degenerative disc disease were selected to participate in the study. They underwent discectomy with a flexible artificial disc with a mean follow-up period of 24.8 months. Outcomes were evaluated with the visual analogue scale (VAS) and Oswestry Disability Index (ODI). Mechanical endurance was evaluated by a dynamic testing.

RESULTS

Fifty one-levels and six bi-levels were included in the study (average age 41.8 years). VAS improved from 6.8 ± 2.2 to 1.5 ± 1.7 (P<0.05) and ODI improved from 43.1 ± 10.4 to 18.2 ± 10.2 (P<0.05). Disc height before mechanical testing was 8.9 mm, and decreased to 8.4 mm after six million cycles with no mechanical failure.

CONCLUSION

Our results indicate that flexible and mono-unit cervical disc provides favorable mechanical performance and clinical outcomes for at least a relatively intermediate-term follow up period. It is indicated that the flexible cervical disc maintains mobility at the level of the prosthesis that is comparable with preoperative ranges of motion. Further evaluation will be completed once long-term results have been obtained.

Technical notes: a self-designed, simple, secure, and safe six-loop intracorporeal Pringle's maneuver for laparoscopic liver resection

BACKGROUND

The aim of this study is to design a simple, secure, and safe technique of intracorporeal Pringle's maneuver to facilitate safer laparoscopic liver resection.

METHODS

A self-designed six-loop catheter was made using 20-French T-tube and 10-French nelaton urethral catheter. The cross head and stem of the T-tube were trimmed to 1 cm, respectively. The nelaton was shortened to 12-cm-long tube from the round tip, and the cut end was inserted and sutured to the stem of the T-tube. After establishment of pneumoperitoneum, the T-tube with nelaton was placed into the abdomen. The round end of the nelaton was inserted into the lesser sac and pulled through the foramen of Winslow, and the end of nelaton was then inserted into one end of the T-tube and pulled through the other end, forming a six-loop. The nelaton was pulled to occlude the hepatic inflow and temporarily fixed with 1-0 Vicryl on a curved round needle on the other end of the T-tube. The protocol of Pringle's maneuver was 15-min clamp and 5-min release periods. The liver parenchymal transection was performed using Harmonic scalpel.

RESULTS

From November 2009 to August 2011, 20 patients received laparoscopic liver resection using the six-loop Pringle's maneuver. During operation, 17 patients were positioned supine, 2 patients in left decubitus, and 1 patient in supine followed by left decubitus position. There were 9 anatomical resections and 11 nonanatomical resections (18 patients for single lesion, 1 for two lesions, and 1 for three lesions). The average times of liver resection and Pringle's maneuver were 33.1 and 36.2 min, respectively. Mean blood loss was 102.5 ml. The postoperative course was uneventful, and average hospital stay was 4.4 days.

CONCLUSION

Our self-designed six-loop intracorporeal Pringle's maneuver can facilitate safer laparoscopic liver resection.

Combination of baclofen and antimuscarinics to reduce voiding difficulty in treating women with overactive bladders

PURPOSE OF STUDY

To evaluate the efficacy of baclofen in combination with antimuscarinics to treat women with an overactive bladder (OAB) with abnormal voiding patterns.

METHODS

An action research and chart review was conducted in 245 OAB women. Women were prescribed tolterodine or oxybutynin with or without baclofen after urodynamics. The complaint of voiding difficulty was followed up one week later.

RESULTS

There was a significant difference in the occurrence of voiding difficulty after antimuscarinic administration in OAB women with abnormal voiding patterns compared with normal patterns (18% vs 4.9%, respectively; p = 0.013). The clinical difference of voiding difficulty after treating with antimuscarinics between both voiding patterns disappeared after adding baclofen (abnormal voiding pattern vs normal pattern; 11.1% vs. 5.6%, respectively; p = 1.000).

CONCLUSION

Combined use of baclofen and antimuscarinic agents could reduce voiding difficulty in treating women with overactive bladders with abnormal voiding patterns.

Melittin liposomes surface modified with poloxamer 188: in vitro characterization and in vivo evaluation

Melittin liposomes surface modified with poloxamer 188 were developed, and the effect of poloxamer 188 was investigated with regard to anti-cancer effect and vascular stimulation. Melittin liposomes surface modified with poloxamer 188 at different concentrations (0%, 2%, and 5%) were prepared using the adsorption method, followed by in vitro characterization, including entrapment efficiency, zeta potential, particle size, and morphology. Subsequently, the influence of repeated freeze-thawing on the liposomes was investigated, and the effect of poloxamer 188 on the repeated freeze-thawing process was explored. Vascular stimulation effects of MLT, and MLT liposome that surface coated with or without poloxamer were all studied. Pharmacokinetics of the different MLT preparations were determined and the anticancer activity of the MLT formulations was investigated. The particle size of the liposomes gradually increased with increasing poloxamer 188 content, while the entrapment efficiency did not change significantly. After the first freeze-thaw cycle, size and PDI were both markedly reduced, entrapment efficiency rose, and there was no significant change of zeta potential. The vascular irritation caused by MLT could be reduced to an extent by encapsulation in liposome, but not completely eliminated, while liposomes coated with poloxamer 188 can effectively abolish the phenomenon. Melittin liposomes with surface modified by poloxamer exhibit enhanced bioavailability, effective anticancer activity, and reduced side effects compared with melittin solution. Poloxamer plays an important role in melittin liposomes.

Extracorporeal shockwave for hip necrosis in systemic lupus erythematosus

Patients with systemic lupus erythematosus (SLE) frequently received corticosteroid therapy, resulting in osteonecrosis of the femoral head (ONFH). Prior studies demonstrated the effectiveness of extracorporeal shockwave treatment (ESWT) for ONFH.. This study evaluated the effectiveness of ESWT for ONFH in patients with SLE. We studied 39 patients, including 15 patients with SLE (26 hips) and 24 controls (29 hips). To each affected hip we applied ESWT (6000 impulses at 28 kV in a single session). Patients were ambulated with partial weight bearing for 4-6 weeks. The primary endpoint was the need for hip replacement. The secondary endpoints were improvement in hip pain and function and image changes on X-ray and MRI. Patients received total hip replacement in 12% of patients with SLE and in 14% of controls (P = 0.802). There was no statistically significant difference in pain scores (0.86 vs. 0.89; P = 0.467) and function scores (89% vs. 91%; P = 0.194) between patients with SLE and controls. SLE response to ESWT for ONFH is comparable with ONFH in patients without SLE.

Dietary selection of sheep grazing the semi-arid grasslands of Inner Mongolia, China at different grazing intensities

The objective of this study was to investigate dietary selection of sheep grazing semi-arid grassland in Inner Mongolia, China, using the difference in organic matter digestibility (OMD) of herbage ingested and herbage on offer as indicator for selection. Faecal N was used as digestibility index for herbage ingested (FOMD), while OMD of herbage on offer (GOMD) was estimated from gas production obtained by the Hohenheim gas test. It was hypothesized that the difference between FOMD and GOMD is high, when grazing animals select against low quality herbage provided that herbage is abundant. In a grazing experiment, six grazing intensities (1.5, 3.0, 4.5, 6.0, 7.5 and 9.0 sheep/ha), representing light to very heavy grazing intensity for the semi-arid grassland, were compared. The amount of herbage on offer decreased with increasing grazing intensity. Independent statistical analysis of FOMD and GOMD showed that the differences between grazing intensities for both OMD determinations (FOMD: 54.0-57.3%, GOMD: 55.2-57.5%) were not significant (p > 0.05). The difference between FOMD and GOMD was not significant for grazing intensities, but varied between sampling periods from -4 to 1 percentage units. In conclusion, the lack of significance for the difference between FOMD and GOMD suggests that for the semi-arid grassland of Inner Mongolia, China, sheep did not select their feed due to a homogeneous nutritional composition of herbage on offer in 2005, regardless of grazing intensity.

Quality indicators and quality assessment in child health

Quality indicators are systematically developed statements that can be used to assess the appropriateness of specific healthcare decisions, services and outcomes. In this review, the range and type of indicators that have been developed for children in the UK and USA by prominent governmental agencies and private organisations are highlighted. These indicators are classified in an effort to identify areas of child health that may lack quality measures. The current state of health information technology in both countries is reviewed, since these systems are vital to quality efforts. Finally, several recommendations are proposed to advance the quality indicator development agenda for children. The convergence of quality measurement and indicator development, a growing scientific evidence base and integrated information systems in healthcare may lead to substantial improvements for child health in the 21st century.

The effects of strontium ranelate in Asian women with postmenopausal osteoporosis

The aim of this study was to assess the efficacy and safety of strontium ranelate in the treatment of postmenopausal women with osteoporosis in Taiwan. In this 12-month multicenter, randomized, double-blind, placebo-controlled study, 125 women with osteoporosis were randomly given either strontium ranelate 2 g daily or placebo. Lumbar spine, femoral neck, and total-hip bone mineral density (BMD) and biochemical markers of bone turnover were measured; adverse events and tolerability were recorded and assessed. Subjects treated with strontium ranelate showed significant increases in BMD of 5.9% at the lumbar spine, 2.6% at the femoral neck, and 2.7% at the total hip, while the placebo group exhibited no significant change at 12 months. Serum level of a formation marker (bone-specific alkaline phosphatase) was also significantly increased at 6 and 12 months. Thus, although the sample size and the treatment duration of this study could not show its effect of reducing osteoprotic fractures, strontium ranelate showed bone protection effects by increasing BMD and concentrations of a bone formation marker. Safety assessment revealed adverse events were mild and not significantly different from placebo.

The effect of polyethylene thickness in fixed- and mobile-bearing total knee replacements

In this paper fixed- and mobile-bearing implants were simulated using a multibody dynamic model and a finite element model to investigate the contact pressure distribution in the ultra high molecular weight polyethylene tibial bearing component. The thickness of polyethylene varied from 6.8 to 12.3 mm and the polyethylene was modelled as a non-linear material. It was found that the contact pressure on the polyethylene decreased in the fixed-bearing implant when the thickness of polyethylene increased from 6.8 to 8 and 9.6 mm, but there was little further decrease in pressure with the increase of polyethylene thickness from 9.6 to 11.0 and 12.3 mm. In the mobile-bearing implant, no increase in contact pressure on the superior surface was found with the increase in the thickness of the polyethylene; however, the contact pressures on the inferior contact surface of the thicker designs were higher than those in the 6.8 mm design. The numerical results obtained in this paper are in good agreement with published experimental test results. Moreover, the paper presents a detailed pressure distribution on the tibial bearing component during a full gait cycle.

A genome segment on mouse chromosome 12 determines maxillary growth

The primary and modifier genes that regulate normal maxillofacial development are unknown. Previous quantitative trait locus (QTL) analyses using the F2 progeny of 2 mouse strains, DBA/2J (short snout/wide face) and C57BL/6J (long snout/narrow face), revealed a significant logarithm-of-odds (LOD) score for snout length on mouse chromosome 12 at 44 centimorgan (cM). We further sought to validate this locus contributing to anterior-posterior dimensions of the upper mid-face at the D12Mit7 marker in a 44-centimorgan portion of chromosome 12. Congenic mice carrying introgressed DNA from DBA/2J on a C57BL/6J background were selected for submental vertex cephalometric imaging. Results confirmed QTLs, determining that short snout length (P < 0.05) and face width relative to snout length (P < 0.01) were present in the 44-cM region of chromosome 12. We conclude that one or more genes contributing to the shape of the maxillary complex are located near 44 cM of mouse chromosome 12.

A dynamic model of simulating stress distribution in the distal femur after total knee replacement

The aim of this study has been to develop a dynamic model of the knee joint after total knee replacement (TKR) to analyse the stress distribution in the distal femur during daily activities. Using MSC/ADAMS and MSC/MARC software, a dynamic model of an implanted knee joint has been developed. This model consists of the components of the knee prosthesis as well as the bones and ligaments of the knee. The femur, tibia, fibula, and patella have been modelled as mixed cortico-cancellous bone. The distal part of femur has been modelled as a flexible body with springs used to simulate the ligaments positioned at their anatomical insertion points.

With this dynamic model a gait cycle was simulated. Stress shielding was identified in the distal femur after TKR, which is consistent with other investigators' results. Interestingly, higher stresses were found in the bone adjacent to the femoral component peg.

This dynamic model can now be used to analyse the stress distribution in the distal femur with different load conditions. This will help to improve implant designs and will allow comparison of prostheses from different manufacturers.