Efficacy and safety of glimepiride/metformin sustained release once daily vs. glimepiride/metformin twice daily in patients with type 2 diabetes

AIMS

The study investigated the clinical equivalence in reducing haemoglobin A1c (A1C) between glimepiride/metformin sustained release (GM-SR) 2/500 mg, a fixed-dose combination, once daily and glimepiride/metformin (GM) 1/250 mg, a fixed-dose combination, twice daily in patients with type 2 diabetes (T2D).

METHODS

A multicentre, randomised, double-blind, double-dummy study was conducted in 14 hospitals in Korea. Inclusion criteria were age 30-75 years, T2D diagnosis no longer than 10 years previously, A1C between 7% and 10%, and body mass index <40 kg/m(2) . A total of 207 subjects were randomised into the GM-SR group (n=101) or the GM group (n=106). Participants were assessed at baseline, 8 weeks and 16 weeks after treatment.

RESULTS

After 16 weeks treatment, no difference in baseline-adjusted changes of A1C (primary efficacy variable) was observed between the two groups (-0.59% for GM-SR group vs. -0.61% for GM group, 95% CI: -0.17 to 0.21; p=0.84). In addition, there were no significant differences in secondary efficacy parameters between the two groups, including changes in A1C up to week 8, changes in fasting plasma glucose (FPG) and 2-h-postprandial plasma glucose up to week 8 and week 16, response rate, drug compliance and hypoglycaemic events. However, there was a difference in baseline-adjusted changes of FPG between the two groups (-1.01 mmol/l for GM-SR group vs. -1.52 mmol/l for GM group, p=0.01 in the intention to treat set).

CONCLUSIONS

GM-SR 2/500 mg once daily was as effective as GM 1/250 mg twice daily in lowering A1C. In addition, no difference was noted in hypoglycaemic events between the two groups.

Upregulation of stromal cell-derived factor by IL-17 and IL-18 via a phosphatidylinositol 3-kinase-dependent pathway

Th17 cells that produce interleukin (IL)-17 play a key role in the pathogenesis of autoimmune inflammation. Among the various cytokines that are involved in the IL-17 pathway, members of the IL-1β family, including IL-18, have recently gained attention. In this study, we stimulated synovial fibroblasts with a combination of IL-17 and IL-18 and quantified their stromal cell-derived factor-1 (SDF-1) production by enzyme-linked immunosorbent assay and their transcript levels by reverse transcription-polymerase chain reaction. Both IL-17 and IL-18 significantly increased the level of SDF-1, not only individually but also synergistically (P< 0.05). The synergism was effectively suppressed by anti-IL-17 and -IL-18 antibodies, and a PI3K inhibitor. To the best of our knowledge, this is the first report of PI3K-dependent synergism between IL-18 and IL-17, and this work adds a novel perspective of the role of IL-18 in immune regulation. The individual effects of these two cytokines, and their interactions, suggest an interrelationship between the IL-1 family and IL-17.

Astaxanthin modulates age-associated mitochondrial dysfunction in healthy dogs

Young (2.97±0.01 yr; 8.16±0.15 kg BW) and geriatric (10.71±0.01 yr; 9.46±0.18 kg BW) healthy female Beagle dogs (n=14/age group) were fed 0 or 20 mg astaxanthin daily for 16 wk to examine modulation of mitochondrial function. Fasted blood was sampled on wk 0, 8, and 16. Mitochondria membrane permeability, ATP production, cytochrome c oxidase/reductase, and number were assessed in leukocytes whereas astaxanthin uptake, glutathione, superoxide dismutase, nitric oxide, 8-hydroxy-2'-deoxyguanosine, 8-isoprostane, and protein carbonyl were measured in plasma. Aging increased (P<0.05) complex III cytochrome c oxidoreductase but decreased (P<0.05) 8-hydroxy-2'-deoxyguanosine and protein carbonyl. Mitochondrial function improved in both young and geriatric dogs by increasing (P<0.05) ATP production, mitochondria mass, and cytochrome c oxidoreductase activity, especially in geriatric dogs compared with young dogs. Astaxanthin feeding also increased (P<0.05) the reduced glutathione to oxidized glutathione ratio in young dogs and decreased (P<0.05) nitric oxide in both young and geriatric dogs. Dietary astaxanthin improved mitochondrial function in blood leukocytes, most likely by alleviating oxidative damage to cellular DNA and protein.

Randomized clinical trial of robot-assisted versus standard laparoscopic right colectomy

BACKGROUND

Robotic surgery was invented to overcome the demerits of laparoscopic technique. However, it is unclear whether robot-assisted colectomy (RAC) has significant clinical advantages over laparoscopically assisted colectomy (LAC) in treating colonic cancer. The aim of this study was to compare the surgical outcomes of RAC versus LAC for right-sided colonic cancer.

METHODS

Patients with right-sided colonic cancer were randomized to receive RAC or LAC. The primary outcome measure was length of hospital stay. Secondary outcomes were duration of operation, morbidity, postoperative pain, hospital costs and pathological quality of the specimen.

RESULTS

Of 71 patients randomized, 70 (35 in each group) were included in the analysis. Hospital stay, surgical complications, postoperative pain score, resection margin clearance and number of lymph nodes harvested were similar in both groups. The duration of surgery was longer in the RAC group (195 versus 130 min; P < 0·001). No conversion to open surgery was needed in either group. Overall hospital costs were significantly higher for RAC (US $ 12,235 versus $ 10,320; P = 0·013); the higher costs were attributed primarily to the costs of surgery, including consumables.

CONCLUSION

Robotic-assisted laparoscopic right colectomy was feasible but provided no benefit to justify the greater cost.

REGISTRATION NUMBER

NCT01042743 (http://www.clinicaltrials.gov).

Roles of ultrasonography and computed tomography in the surgical management of cervical lymph node metastases in papillary thyroid carcinoma

AIMS

Adequate evaluation and surgical management of cervical lymph node metastasis is very important in papillary thyroid carcinoma (PTC). The aim of this study was to evaluate the impact of preoperative ultrasonography (US) and computed tomography (CT) on the surgical management of cervical lymph node metastases in PTC.

METHODS

Medical records and imaging findings were retrospectively analyzed for 252 patients with PTC who underwent thyroidectomy with neck dissection.

RESULTS

The sensitivity of both imaging techniques was lower in the central neck (US 23%, CT 41%) than in the lateral neck (US 70%, CT 82%). The specificities of US and CT were 97% and 90% in the central neck, and 84% and 64% in the lateral neck, respectively. Our surgical plans for therapeutic neck dissection were based on imaging findings in 59% of patients who underwent lateral compartment neck dissection and in 32.1% of patients who underwent central compartment neck dissection, respectively.

CONCLUSIONS

The roles of preoperative US and CT in surgical planning for central compartment neck dissection in PTC are limited because of their low sensitivity in the central neck, but US and CT may be useful in cases with non-palpable lateral neck nodes.

Difference of regeneration potential between healthy and diseased liver

BACKGROUND

We sought to evaluate total and segmental liver regeneration by comparing preoperative computed tomographic (CT) volumetry and CT volumetry on postoperative day (POD) 7 after a right hepatectomy, in patients with various status and surgical indications.

METHOD

We included 36 patients who underwent right lobectomy for living donor liver transplantation (healthy group), and 29 for hepatocellular carcinoma treatment (disease group). All of the disease group patients were Child-Turcotte-Pugh (CTP) class A. The regeneration of lateral, medial segment and total remnant liver volumes were assessed on POD 7 using a CT-based program. Total volumes and segmental volumes were measured for total liver, future liver remnant (FLR), and liver remnant. We calculated total and segmental early regeneration indexes, defined as [(VLR-VFLR)/VFLR]×100, where VLR is volume of the liver remnant and VFLR is volume of the FLR.

RESULT

The VLR at POD 7 showed a 72.9% increase in volume among the healthy versus 55% in the disease group, (P=.012) In the disease group, segmental volume and regeneration indexes were also significantly lower than among the healthy group: 59.0% versus 46.9% in the medial and 86.8% versus 57.7% in the lateral segment (P=.023 and P<.001) respectively.

CONCLUSION

The volume regeneration potential in diseased livers is significantly lower than that of a normal, healthy liver. So, we must consider a patient's liver status and volume profile before an extensive liver.

Evaluation of sulfur and multi-walled carbon nanotube composite synthesized by dissolution and precipitation for Li/S batteries

An elemental sulfur and multi-walled carbon nanotube (S-MWNT) composite was synthesized by dissolving sulfur in ammonium sulfides and then precipitating on MWNT. Morphology observation by scanning electron microscopy (SEM) confirmed that S-MWNT product was successfully prepared by incorporating sulfur into MWNT network. Without additional conducting material, the S-MWNT composite cathodes were prepared for electrochemical tests. The properties measured in discharge-charge cycling test showed that the composite had the initial discharge capacity of 1024 mAh g(-1), which is about 61% sulfur utilization. However, in the subsequent cycling, the capacities faded. To determine the reason of rapid capacity drop, S-MWNT composite cathodes were compared in the cycling tests with varying three kinds of electrolytes and the cathode was subjected to physical force by rolling. The changes in the cycle performances proved that the deterioration of S-MWNT composite cathodes was not related to the electrolytes but to physical bonding that may not maintain the conducting path between sulfur and MWNT.

Observation of reactor electron antineutrinos disappearance in the RENO experiment

The RENO experiment has observed the disappearance of reactor electron antineutrinos, consistent with neutrino oscillations, with a significance of 4.9 standard deviations. Antineutrinos from six 2.8  GW(th) reactors at the Yonggwang Nuclear Power Plant in Korea, are detected by two identical detectors located at 294 and 1383 m, respectively, from the reactor array center. In the 229 d data-taking period between 11 August 2011 and 26 March 2012, the far (near) detector observed 17102 (154088) electron antineutrino candidate events with a background fraction of 5.5% (2.7%). The ratio of observed to expected numbers of antineutrinos in the far detector is 0.920±0.009(stat)±0.014(syst). From this deficit, we determine sin(2)2θ(13)=0.113±0.013(stat)±0.019(syst) based on a rate-only analysis.

Colorectal cancer pulmonary oligometastases: pooled analysis and construction of a clinical lung metastasectomy prognostic model

BACKGROUND

Although resecting colorectal cancer (CRC) pulmonary metastasis is associated with long-term survival, identification of prognostic groups is needed for future randomized trials, and construction of a lung metastasectomy prognostic model (LMPM) is warranted.

PATIENTS AND METHODS

We searched the PubMed database for retrospective studies evaluating prognostic factors following resecting CRC lung metastasis. Individual patient data were analyzed. Independent prognostic factors were used to construct an LMPM.

RESULTS

Between 1983 and 2008, 1112 metastasectomies were carried out on 927 patients included in eight studies. Five-year survival rate was 54.3% following the first lung resection. Multivariate analysis identified three independently poor prognostic factors: pre-thoracotomy carcinoembryonic antigen ≥5 ng/ml, disease-free interval <36 months, and more than one metastatic lesion. Patients with good-, intermediate-, and high-risk groups according to the LMPM had a 5-year survival of 68.2%, 46.4%, and 26.1%, respectively (P < 0.001). Perioperative chemotherapy and previously resected liver metastasis had no influence on survival.

CONCLUSIONS

The low- and intermediate-risk groups have a good chance of long-term survival following metastasectomy. However, more studies are needed to investigate whether surgery offers any advantage over systemic therapy for the poor-risk group.

Ultrasound-based diagnostic classification for solid and partially cystic thyroid nodules

BACKGROUND AND PURPOSE

The ability of US to differentiate benign thyroid nodules from malignant ones is still a matter of debate. The aim of this study was to assess the diagnostic efficacy of a US-based classification system for solid and PCTNs through a prospectively designed study.

MATERIALS AND METHODS

We studied 1289 thyroid nodules in 1036 patients who underwent thyroid US, US-FNA, and thyroid surgery. Each thyroid nodule was prospectively classified into 1 of 5 diagnostic categories following real-time US examination: benign, probably benign, borderline, possibly malignant, and malignant. Solid nodules were classified by using all 5 categories, and PCTNs were classified by all except the borderline category. We calculated the diagnostic efficacy of thyroid US by comparing US diagnoses with histopathologic results of surgically resected thyroid nodules.

RESULTS

One thousand fifty-five solid nodules and 234 PCTNs were prospectively classified as benign (n = 435 and 179), probably benign (n = 213 and 25), borderline (n = 94 and 0), possibly malignant (n = 115 and 15), and malignant (n = 198 and 15), respectively. Of these 1289 nodules, 505 were surgically resected and confirmed by pathology (191 benign and 314 malignant nodules); there were 44 resected solid nodules with a borderline category. For solid nodules and PCTNs, the sensitivity, specificity, positive and negative predictive values, and accuracy of US diagnosis were 86.1 and 66.7, 90.0 and 88.9, 94.3 and 75.0, 77.3 and 84.2, and 87.5% and 81.5%, respectively, based on 505 surgical specimens and excluding the 42 solid borderline nodules.

CONCLUSIONS

Our US-based classification system can provide helpful guidance for the management of thyroid nodules.

Serum capacity to neutralize superantigens does not affect the outcome of Staphylococcus aureus bacteremia

Staphylococcal superantigens (SAg) could play an important role in sepsis by activating numerous T cells. We investigated whether serum capacity to neutralize SAgs can be a prognostic factor in Staphylococcus aureus bacteremia (SAB). In a university hospital, 105 consecutive SAB patients were enrolled during a 12-month period. The earliest serum samples prior to SAB onset were stored for a later T cell proliferation assay. Multiplex polymerase chain reaction (PCR) for 19 SAg genes was performed for S. aureus blood isolates. To determine the serum capacity to neutralize SAgs, T cell proliferation by the culture supernatant of each S. aureus isolate was measured in the presence and absence of the corresponding patient's serum. Twenty-six (24.8%) patients died within 4 weeks from SAB onset. Vascular catheter-related infection was associated with survival for ≥4 weeks. Unknown primary focus, Simplified Acute Physiology Score-II (SAPS-II), and specific SAg genes (tst, sec, sel, or sep) were associated with the 4-week mortality. No variables related to T cell proliferation assay showed statistical significance. In the multivariate analysis, SAPS-II ≥33 and tst were independently associated with the 4-week mortality. Serum capacity to neutralize SAg does not significantly affect SAB outcome. SAPS-II ≥33 and tst are independent predictors of the 4-week mortality.

A huge retroperitoneal liposarcoma: case report

BACKGROUND

Soft tissue sarcomas are rare and account for less than 1% of all newly diagnosed malignancies. One-third of malignant tumors arising in the retroperitoneum are sarcomas. Liposarcoma is the most common soft tissue sarcoma and retroperitoneal sarcoma. Liposarcoma accounts for at least 20% of all sarcomas in adults and up to 41% of all retroperitoneal sarcomas. Here we present the case of a huge retroperitoneal liposarcoma and a brief literature review.

CASE REPORT

A 34-year-old woman was referred to our hospital from a local clinic, because of abdominal distention, pain, and palpable mass. On admission we found that her abdomen was markedly distended. Computed tomography showed a the huge left ovarian mass that occupied almost the entire abdominal cavity. The mass consisted mainly of fat, and calcified material. She was operated under the diagnosis of a huge teratoma. The tumor was located in the retroperitoneal cavity and it abutted the left adnexa. The retroperitoneal tumor, including the left adnexa was removed. The tumor measured 22 x 15 x 11 cm, and showed many histological and pathological findings. On the basis of the histopathological finding, the tumor was diagnosed as a dedifferentiated liposarcoma of the retroperitoneum. The patient is presently undergoing radiation therapy.

CONCLUSION

In retroperitoneal liposarcoma, histological subtype, incomplete resection, contiguous organ resection, and older age are strongly associated with tumor-related mortality. For liposarcoma, it is necessary to customize the treatment strategy on a case-by-case basis.

A prospective longitudinal study evaluating the usefulness of a T-cell-based assay for latent tuberculosis infection in kidney transplant recipients

We evaluated whether ELISPOT assay can predict tuberculosis (TB) development in kidney-transplantation (KT) recipients with a negative tuberculin skin test (TST). All adult patients admitted to a KT institute between June 2008 and December 2009 were enrolled; TB development after KT was observed between June 2008 and December 2010. Isoniazid (INH) was given to those patients with positive TST or clinical risk factors for latent TB infection (LTBI). ELISPOT assay was performed on all patients, and TB development after KT was observed by a researcher blinded to the results of ELISPOT. A total of 312 KT recipients including 242 (78%) living-donor KT were enrolled. Of the 312 patients, 40 (13%) had positive TST or clinical risk factors for LTBI and received INH; none developed TB after KT. Of the remaining 272 patients, 4 (6%) of 71 with positive ELISPOT assay developed TB after KT, whereas none of the 201 patients with negative (n = 171) or indeterminate ELISPOTs (n = 30) developed TB after KT (rate difference between positive and negative/indeterminate ELISPOT, 3.3 per 100 person-years [95% CI 1.4-5.1, p<0.001]). Positive ELISPOT results predict subsequent development of TB in KT recipients in whom LTBI cannot be detected by TST or who lack clinical risk factors for LTBI.

The effects of outdoor air supply rate on work performance during 8-h work period

The purpose of this study is to evaluate the effect of ventilation rate on work performance and perceived air quality through short-term laboratory experiments. The experiment was designed to simulate office work, and a laboratory space was modified using new finish materials to become a typical office space. High levels of volatile organic compounds (VOCs) were found in the exposure chamber, most probably originating from the new finishing materials that were present. Twenty-four subjects were divided into six groups that were randomly exposed to the three ventilation rates, 5, 10, and 20 l/s per person. The subjects performed work tasks three separate times for each ventilation rate over an 8-h exposure period. The work performance of the subjects logarithmically improved with increased ventilation rates, which was similar to the previous research findings. Statistical significance was found for addition task, text-typing task, and memorization task. Increased work performance in this experiment was slightly lower than the results of previous short-term laboratory experiments, yet remained higher than results of previous long-term field experiments. However, it was difficult to directly compare the results of this experiment with those of previous experiments, because of the higher concentration of VOC present in the office rooms and the learning effect associated with the repeated tasks.

PRACTICAL IMPLICATIONS

The results of this experiment show that ventilation had positive impacts on perceived air quality and work performance for the subjects tested. Work performance logarithmically increased by approximately 2.5-5% as ventilation rates were increased from 5 to 20 l/s per person. The positive effect of ventilation rate on work performance was shown to be limited at the low ventilation rate. The positive effects on work performance were at lower ventilation rates. The learning effect in repeated work performance tasks could increase the uncertainty of the work performance analysis in 8-h exposure period.

Impact of antibiotic prophylaxis on postbronchoscopy fever: a randomised controlled study

BACKGROUND

Postbronchoscopy fever can develop in 5-16% of adult patients. The microbiological contribution to postbronchoscopy fever is unclear.

OBJECTIVE

To elucidate the effect of prophylactic antibiotics on the development of postbronchoscopy fever and pneumonia.

DESIGN

Study patients were randomised to receive no treatment or oral amoxicillin/clavulanate 30 min before flexible bronchoscopy. The primary outcome variable was the frequency of postbronchoscopy fever and pneumonia. White blood cell counts, C-reactive protein and the serum pyrogenic cytokines interleukin (IL) 1β, IL-6 and tumour necrosis factor-alpha were measured before and after bronchoscopy.

RESULTS

Of 143 subjects enrolled in the study, the final analysis was performed among 67 subjects in the prophylaxis group and 64 in the control group. The frequency of postbronchoscopy fever did not differ between the groups (25.4% for the prophylaxis group vs. 26.6% for controls, P > 0.05). Pneumonia developed in 1.5% of the prophylaxis group and 4.7% of the controls. There was no bacteraemia in either group. Serum pyrogenic cytokines did not differ between the groups.

CONCLUSIONS

Prophylactic antibiotics before bronchoscopy did not reduce the frequency of postbronchoscopy fever and did not affect serum levels of pyrogenic cytokines. These findings suggest that microbiological factors may not be responsible for the development of postbronchoscopy fever.

A study on white organic light-emitting diodes co-doped with red fluorescent and blue phosphorescent dopants

White organic light-emitting diodes (WOLEDs) have drawn increasing attention due to their potential use in various applications such as solid-state lighting and backlight of liquid crystal displays and full-color OLEDs of red, green, and blue pixel. N,N'-dicabazolyl-3,5-benzene (mCP), the host material, was co-doped with Iridium (III) bis[(4,6-difluorophenyl)-pyridinato-N,C2']-picolinate (FIrpic), which functions not only as phosphorescent sensitizer but also blue emitter, and (2Z,2'Z)-3,3'-[4,4"-bis (dimethylamino)-1,1':4',1"-terphenyl-2',5'-diyl]bis (2-phenylacrylonitrile) (ABCV-P), which is a red fluorescent material. The fabricated device structures were as follows: (device A) Indium tin oxide (ITO)/N,N'-bis-(1-naphyl)-N,N'-diphenyl-1,1'-biphenyl-4,4'-diamine (NPB)/(mCP)/mCP:ABCV-P (1%)/4,7-diphenyl-1,10-phenanthroline (Bphen)/lithium quinolate (Liq)/aluminum (Al), (device B) ITO/NPB/mCP/mCP:FIrpic (8%)/Bphen/Liq/Al and (device C) ITO/NPB/mCP/mCP:FIrpic:ABCV-P (8%, 1%)/Bphen/Liq/Al, respectively. Phosphorescent FIrpic harvesting both singlet and triplet excitions not only emitted blue light but also transferred energy to fluorescent ABCV-P. The maximum luminance efficiency, external quantum efficiency, and luminance of white light device were measured to be 5.95 cd/A, 2.45% and 2500 cd/m2, respectively. The white device gave practically white light with the Commision Internationale de l'Eclairage (CIE(xy)) coordinate of (0.44, 0.49) which was close to warm white color (CIE(xy) = 0.45, 0.45).

Prediction of acute pulmonary complications after resection of lung cancer in patients with preexisting interstitial lung disease

INTRODUCTION

Interstitial lung disease (ILD) is associated with a high morbidity from acute pulmonary complications, such as acute lung injury (ALI) or acute respiratory distress syndrome (ARDS), after pulmonary resection. This study attempts to uncover the risk factors for postoperative ALI/ARDS in lung cancer patients with ILD.

MATERIALS AND METHODS

We retrospectively reviewed 100 patients with ILD who underwent curative lung resection for lung cancer, from January 2000 to December 2008.

RESULTS

Of the 100 patients, 91 were male, and 9 were female. The median age was 66 years. Fifty-eight patients underwent a preoperative carbon monoxide diffusing capacity test (DLCo). Twelve pneumonectomies and 88 lobectomies were performed. Acute pulmonary complications were observed in 28 patients (13 with ALI and 15 with ARDS). Operative mortality was 14%. Cause of death was due to respiratory failure from ALI/ARDS in all patients, except in one patient who died due to complications of acute renal failure. For all 100 patients, univariate analysis revealed that preexisting comorbidities, such as ischemic heart disease, renal failure, COPD, and neoadjuvant treatment for lung cancer, were risk factors for the development of postoperative ALI/ARDS. For the 58 patients who underwent preoperative DLCo testing, significant univariate risk factors included preexisting comorbidities and decreased DLCo. Multivariate analysis did not show any significant risk factors for ALI/ARDS.

CONCLUSIONS

Preexisting comorbidities and decreased preoperative DLCo were the most significant risk factors for the development of acute pulmonary complications after pulmonary resection in patients with lung cancer and ILD.

Hyperuricemia in kidney transplant recipients with intact graft function

OBJECTIVES

The aim of this study was to investigate the prevalence of hyperuricemia and factors predicting its occurrence, and to establish the relationship over time between serial changes in estimated glomerular filtration rate (eGFR) and uric acid (UR) concentration in kidney transplant (KT) recipients with eGFR >60 mL/min/1.73 m(2).

METHODS

Adult patients who underwent KT at the Asan Medical Center between 1990 and 2008 and maintained eGFR >60 mL/min/1.73 m(2) were retrospectively assessed. Clinical and laboratory data were obtained from inpatient and outpatient charts and from the hospital electronic database.

RESULTS

Of 356 patients, 301 (84.55%) had normal UR levels and 55 (15.45%) had hyperuricemia. After multivariate adjustment, transplant duration, male gender, eGFR, diabetes mellitus (DM), and calcium level were associated with higher mean UR levels. Mean UR level increased significantly and mean eGFR decreased significantly during the first year after transplantation, but there were no significant differences over the next 4 years. Serial UR and eGFR levels changed almost simultaneously.

CONCLUSIONS

Transplantation duration, male gender, eGFR level, DM, and serum calcium level were risk factors for hyperuricemia in kidney recipients with intact graft function. Increased uric acid after KT did not significantly affect graft function.

Spinous process fractures in osteoporotic thoracolumbar vertebral fractures

OBJECTIVES

To evaluate the incidence and pattern of spinous process fractures (SPFs) in patients with osteoporotic compression fractures (OCFs) of the thoracolumbar spine.

METHODS

Spinal MRI or CT of 398 female patients (age range 50-89 years, mean age 70 years) who had OCFs in the thoracolumbar spine were retrospectively reviewed. The incidence, location and imaging results for the SPFs were evaluated.

RESULTS

Of the 398 patients who had thoracolumbar OCFs, 14 (3.5%) had SPF. In six patients with single compression fractures, the SPF occurred at the level just above the vertebral compression fracture. In six out of seven patients with multiple continuous compression fractures, the SPF occurred just one level above the uppermost level of the compression fracture. The remaining one patient who had thoracolumbar spinal fixation at T12-L2 with continuous compression fractures in T12-L5 had a SPF in L2. In one patient who had multiple compression fractures in discontinuous levels (fractures at T10 and L1, respectively), the SPF occurred at T12. The directions of the fractures were vertical or oblique vertical (perpendicular to the long axis of the spinous process) in all cases.

CONCLUSION

In the presence of an OCF in the thoracolumbar spine, a SPF was found in 3.5% of cases, and most of the fractures were located just one level above the compression fracture. Therefore, in patients who have OCF, the possibility of a SPF in the level just above the compression fracture should be considered.

Treatment guidelines for isolated dissection of the superior mesenteric artery based on follow-up CT findings

OBJECTIVES

The treatment guidelines for isolated superior mesenteric artery dissection (SMAD) are not well established. The purpose of this study was to report a single-centre series of SMAD and propose treatment guidelines.

MATERIALS AND METHODS

Between November 2004 and December 2009, 30 patients were diagnosed with SMAD. We retrospectively reviewed their medical records.

RESULTS

The subjects included 26 men and four women, with a mean age of 55.1 years. The chief complaint was abdominal pain in 17 patients, whereas 13 patients were asymptomatic. The mean follow-up was 38.3 months. The radiographic findings included intimal flap with a false lumen in 20 patients and intramural haematoma in 10 patients. The treatments included observation in 18 patients, anticoagulation in five patients, stenting in six patients and surgery in one patient. During follow-up (mean 15.6 months), there was no change in the computed tomography scans of seven patients, improvement was observed in four patients and complete resolution was observed in four patients. All patients, including the symptomatic patients, remained asymptomatic during follow-up.

CONCLUSIONS

Most patients with SMAD can be successfully managed with conservative treatment. Surgical treatment or percutaneous intervention can be reserved for patients with severe mesenteric ischaemia and those for whom the initial conservative treatment fails.

Natural orifice specimen extraction versus conventional laparoscopically assisted right hemicolectomy

BACKGROUND

This case-control study compared the clinical outcomes of totally laparoscopic hemicolectomy with natural orifice specimen extraction (NOSE) and the conventional laparoscopically assisted approach for right-sided colonic cancer.

METHODS

Consecutive patients who underwent totally laparoscopic mobilization of the right colon with transvaginal resection, anastomosis and specimen extraction between April 2007 and December 2009 were matched by various clinicopathological characteristics with patients who had conventional laparoscopically assisted procedures.

RESULTS

Thirty-four patients in each group were studied. The number of lymph nodes harvested and the resection margin status were similar in the two groups. After NOSE, patients experienced less pain (mean(s.e.m.) pain score on day 1: 4·2(0·3) versus 5·7(0·3), P = 0·001; on day 3: 2·6(0·2) versus 3·5(0·2), P = 0·010) and had a shorter hospital stay (mean(s.d.) 7·9(0·8) versus 8·8(1·5) days; P = 0·003). The NOSE group had less surgical morbidity than the laparoscopically assisted group, but the difference was not significant (4 of 34 versus 9 of 34; P = 0·119). After a median follow-up of 23 (range 5-40) months, there was no transvaginal access-site recurrence or posterior colpotomy-related complications. NOSE was associated with significantly better cosmetic results (mean(s.d.) score 7·5(1·7) versus 6·6(1·8); P = 0·037).

CONCLUSION

The NOSE approach is feasible with favourable short-term surgical outcomes.

Perpendicular magnetic anisotropy in amorphous ferromagnetic CoSiB/Pt multilayers

Magnetic anisotropy properties of amorphous ferromagnetic CoSiB/Pt multilayers with perpendicular magnetic anisotropy (PMA, K(u)) were systematically investigated as a function of CoSiB layer thickness (t(coSiB)) and Pt layer thickness (t(Pt)). In two series of [CoSiB t(coSiB)Pt t(P1)]5 multilayers, the perpendicular coercivity (H(c)) increased to reach a maximum and then decreased with further increase in both t(coSiB) and t(Pt), due to intermixing of CoSiB/Pt interfaces. Particularly, using the amorphous soft magnetic CoSiB, the coercivity became very sensitive to the CoSiB thickness. These multilayer films exhibited a high K(u) of 2 x 10(6) erg/cc and a high H(c) of 360 Oe with marked squareness. It was found that even after annealing at 350 degrees C, the CoSiB/Pt multilayers had a high PMA and their H(c) increased.

Variations in the STK10 gene and possible associations with aspirin-intolerant asthma in a Korean population

BACKGROUND AND OBJECTIVE

Lymphocyte-oriented kinase deficiency encoded by the serine/threonine kinase 10 (STK10) gene correlates with the intracellular adhesion molecule 1 (ICAM-1)/lymphocyte function associated antigen 1 (LFA-1) complex in aspirin hypersensitivity. This study investigated the association between single nucleotide polymorphisms (SNPs) of STK10 and aspirin-intolerant asthma (AIA).

METHODS

A total of 54 SNPs were genotyped in 163 AIA patients and 429 aspirin-tolerant asthma (ATA) controls.

RESULTS

Logistic regression revealed that a synonymous variant (rs2306961G>A) had the most significant association with AIA (P = .008 under the codominant model; P = .004 under the dominant model), suggesting that tissue-specific codon usage between Lys_TTT and Lys_CTT could play a role in regulating expression of STK10 in airway epithelium. Haplotype analysis revealed that 4 haplotypes, including STK10_BL4-ht1, which is unique to rs2306961G>A, were significantly associated with aspirin hypersensitivity in asthmatics (P < .05).

CONCLUSIONS

Although replications in independent cohorts and further functional evaluations are needed, our preliminary findings suggest that STK10 polymorphisms might be susceptible genetic markers of AIA and that gene expression could be mediated by tissue-specific codon usage.