Bisphosphonate therapy after liver transplant improves bone mineral density and reduces fracture rates: an updated systematic review and meta-analysis.

To investigate the efficacy of bisphosphonates and compare oral and IV formulations on bone mineral density (BMD) and fracture incidence in post-orthotopic liver transplant (OLT) patients. Electronic databases were searched, and six RCTs and three cohort studies were included out of 711 articles. Main outcomes included post-OLT BMD changes, fracture incidence, and treatment adverse reactions. Pairwise meta-analysis was conducted for binary and continuous outcomes, while pooled fracture incidence utilized single-arm meta-analysis. Post-OLT fracture incidence was reported in nine studies (n = 591). Total fracture incidence was 6.6% (CI: 3.4-12.4%) in bisphosphonate group and 19.1% (CI: 14.3-25.1%) in calcium and vitamin D group. Total fractures were significantly lower in patients on bisphosphonate, compared to calcium and vitamin D (n = 591; OR = 0.037; CI: 0.18-0.77; P = 0.008). Overall fractures were significantly lower in the oral group (n = 263; OR = 0.26; CI: 0.08-0.85; P = 0.02) but not in the IV group (n = 328; OR = 0.45; CI: 0.16-1.26; P = 0.129). Both oral and IV bisphosphonates are effective in reducing fracture incidence post-OLT compared to calcium and vitamin D. Oral formulations may also have an advantage over IV in reducing bone loss and fracture incidence post-OLT.

Promotional effects of angiopoietin-1 on functional neovascularization in a swine model with chronic myocardial ischemia / 复旦学报（医学版）

Objective To investigate the long-term angiogenic effects of angiopoietin-1 (ANG-1) and vascular endothelial growth factor (VEGF) in a swine model with chronic myocardial ischemia.Method Four-weeks after gradual occlusion of the left circumflex coronary artery by Ameroid constrictor,animals were injected with recombinant adenoviral vectors carrying either human ANG-1 (AdANG-1 group,n =9),human VEGF 165 (AdVEGF group,n =10) or empty vector (n =7) into the left ventricle free wall supplied by the constricted artery.Four and twelve weeks after the gene transfer mediated by the adenovirus,regional blood flow in ischemic myocardium were respectively measured with fluorescent microsphere while immunohistochemical study were also conducted accordingly.Results Left ventricular perfusion in animals in the AdANG-1 group [(3.25 ± 0.16) mL·min-1·g-1]were significantly higher than that in the AdVEGF group [(1.09 ± 0.13) mL·min-1·g-1] and empty vector group [-(1.20 ± 0.03) mL·min-1·g-1] 4 weeks after gene tranfer (P＜0.05).Microvascular densities in the left ventricles of animals in the AdANG-1 group [(19.61 ± 1.76)/0.572 mm2 myocardial tissue] and the AdVEGF group [(18.17 ± 1.43)/0.572 mm2 myocardial tissue] were significantly higher than animals that received empty vector [(13.53 ± 0.92)/0.572 mm2 myocardial tissue] 12 weeks after gene transfer (P＜0.05).ANG-1,but not VEGF,contributed to enhanced regional perfusion by increasing arteriolar density [(1.9 ± 0.4)/0.572 mm2 myocardial tissue vs.(0.7± 0.2)/0.572 mm2 myocardial tissue,P＜0.05] of large-sized (50-100 μm) arterioles.Conclusions Gene transfer of ANG-1 and VEGF can enhance angiogenesis,but only ANG-1 promotes sustained improvement of ventricular perfusion that expedites recovery of ischemic myocardium via arteriogenesis,which provides histoanatomical prerequisite to expedite recovery of ischemic myocardium.

Epidemiology of invasive Haemophilus influenzae type b disease in Singapore children, 1994-2003.

Invasive Haemophilus influenzae type b (Hib) diseases are major causes of childhood morbidity and mortality. For the period from 1994 to 2003, we retrospectively identified 53 children with invasive Hib disease including 31 with meningitis, 14 with pneumonia, 2 with septic arthritis, 2 with epiglottitis, 1 with neutropenic sepsis, and 3 who were bacteraemic without a focus. Two children died and 22 had serious sequelae; significantly, survivors with sequelae had presented with meningitis (P-value<0.001) or sepsis (P-value=0.001). During the 11-year period, the annual incidence of invasive Hib disease was estimated to be 4.4/100,000 children <5 years old. With rising affluence, decreasing costs of vaccines, and increased costs in caring for survivors, universal infant immunization with Hib vaccine may need to be reconsidered in Singapore.

Risk perception and impact of Severe Acute Respiratory Syndrome (SARS) on work and personal lives of healthcare workers in Singapore: what can we learn?

INTRODUCTION: Healthcare workers (HCWs) were at the frontline during the battle against Severe Acute Respiratory Syndrome (SARS). Understanding their fears and anxieties may hold lessons for handling future outbreaks, including acts of bioterrorism. METHOD: We measured risk perception and impact on personal and work life of 15,025 HCWs from 9 major healthcare institutions during the SARS epidemic in Singapore using a self-administered questionnaire and Impact of Events Scale and analyzed the results with bivariate and multivariate statistics. RESULTS: From 10,511 valid questionnaires (70% response), we found that although the majority (76%) perceived a great personal risk of falling ill with SARS, they (69.5%) also accepted the risk as part of their job. Clinical staff (doctors and nurses), staff in daily contact with SARS patients, and staff from SARS-affected institutions expressed significantly higher levels of anxiety. More than half reported increased work stress (56%) and work load (53%). Many experienced social stigmatization (49%) and ostracism by family members (31%), but most (77%) felt appreciated by society. Most felt that the personal protective measures implemented were effective (96%) and that the institutional policies and protocols were clear (93%) and timely (90%). CONCLUSION: During epidemics, healthcare institutions have a duty to protect HCWs and help them cope with their personal fears and the very stressful work situation. Singapore's experience shows that simple protective measures based on sound epidemiological principles, when implemented in a timely manner, go a long way to reassure HCWs.