Intradiscal steroid injection for the treatment of chronic non-specific low back pain in patients with Modic type 1 change.

OBJECTIVE: The aim of this study was to evaluate and aggregate the evidence from the published studies to determine the effectiveness of intradiscal steroid injection (ISI) in patients with symptomatic Modic type I change (MCI). MATERIALS AND METHODS: A systematic literature search was independently performed by two authors. The electronic database, including PubMed, Embase, the Cochrane Library, and Web of Science, were searched with the given search terms but without language restriction. The studies that met the inclusion criteria were included. The relevant data were extracted, and two authors independently assessed the quality of the included studies. We performed the present study using the STATA software package. RESULTS: The present work included seven studies with 434 patients with chronic low back pain (CLBP). The risk of bias in the included randomized controlled trials (RCTs) was rated from low to unclear, and all the included observational studies were rated as high quality. The result of the meta-analysis revealed that there were significant differences in pain intensity [standardized mean difference (SMD): 3.09, 95% confidence interval (CI): 1.60-4.58; p<0.01] and self-assessed improvement/satisfaction [odds ratio (OR): 11.41, 95% CI: 3.39-38.41; p=0.05] after ISI compared to before treatment. However, no significant differences in the proportion of patients with full or part-time employment (OR: 1.03, 95% CI: 0.55-1.91; p>0.05), receiving additional care for CLBP (OR: 0.78, 95% CI: 0.36-1.71; p>0.05), and serious adverse events (OR: 1.09, 95% CI: 0.58 to 2.05; p>0.05) were detected between the groups. CONCLUSIONS: Among CLBP patients with MCI, the use of ISI was significantly associated with a reduction in pain intensity in the short term.

Blockade of IL-17 alleviated inflammation in rat arthritis and MMP-13 expression.

OBJECTIVE: Rheumatoid arthritis (RA) is one systemic auto-immune disorder featured as chronic synovitis and can destruct joint cartilage. Fibroblast-like synoviocyte (FLS) secretes various factors affecting chondrocyte matrix and degradation. This study thus investigated the effect of interleukin-17A (IL-17A) on FLS and osteoclast. MATERIALS AND METHODS: Type II collagen-induced arthritis (CIA) rats were assigned to CIA model, CIA + IgG1 isotype, and CIA + Anti-Rat IL-17A groups. Tissue volume and arthritis index (AI) evaluated arthritis condition. ELISA and flow cytometry measured IL-17A content and Th17 cell percentage in joint cavity fluid. Matrix metallopeptidase 13 (MMP-13) and collagen type II alpha 1 (COL2A1) expression in synovial tissues were compared. FLS-osteoclast co-culture system was treated with IL-17A + IgG1 Isotype or CIA + Anti-Rat IL-17A. MMP-13 and COL2A1 expression were compared. RESULTS: CIA model rats had significantly higher IL-17A and Th17 cell ratio in joint cavity fluid. Injection of Anti-Rat IL-17A decreased AI and tissue volume in model rats, decreased MMP-13 while increased COL2A1 expression in synovial or cartilage tissues. IL-17A treatment remarkably up-regulated MMP-13 mRNA or protein expression in chondrocytes. Anti-IL-17A weakened effects of IL-17A on FLS or chondrocytes. CONCLUSIONS: IL-17A inhibits COL2A1 mRNA and protein expression of chondrocyte in the co-culture system via inducing MMP-13 expression in FLS, thus enhancing collagen degradation and playing a role in RA-related cartilage injury.

Prevalence of hypertension after living-donor liver transplantation: a prospective study.

BACKGROUND: Hypertension is common among patients who have undergone liver transplantation and is a major contributor to cardiovascular events. Few studies have studied the risk factors associated with post-liver transplantation (LT) hypertension. This prospective study assessed the prevalence of post-LT hypertension and associated preoperative risk factors. METHODS: From May 2008 to December 2009, 79 normotensive adult patients (≥ 18 years old) who underwent living-donor LT with a median follow up of 4.79 ± 0.88 years were enrolled. Patients' pre-LT demographics, clinical data, pre-LT diabetes, and immunosuppressive agents used after LT were studied for their association with post-LT hypertension. RESULTS: The prevalence of post-LT hypertension was 49.4%. The independent risk factors for post-living-donor LT hypertension were pre-LT systolic blood pressure (SBP; odds ratio [OR], 1.04; 95% confidence interval [CI], 1.00-1.09; P = .039) and post-LT administration of mammalian target of rapamycin (mTOR) inhibitors (OR, 4.08; 95% CI, 1.40-11.94; P = .010). Pre-LT diabetes had a negative predictive value (OR, 0.15; 95% CI, 0.03-0.74; P = .019). Neither age, male sex, smoking, pre-LT serum cholesterol and triglyceride levels, tacrolimus, nor glucocorticoid was associated with post-LT hypertension. CONCLUSIONS: The prevalence of hypertension is high after LT. Higher pre-LT SBP and post-LT mTOR inhibitor administration predispose patients to post-LT hypertension.

Antinociceptive potentiation and attenuation of tolerance by intrathecal ß-arrestin 2 small interfering RNA in rats.

BACKGROUND: Tolerance to the analgesic effect of opioids complicates the management of persistent pain states. We tested whether the intrathecal infusion of small interfering RNA (siRNA) against ß-arrestin 2 would reduce tolerance to chronic morphine use and the severity of precipitated morphine withdrawal. METHODS: Intrathecal ß-arrestin 2 (2 µg siRNA per 10 µl per rat) was injected once daily for 3 days. Rats then received a continuous intrathecal infusion of morphine (2 nmol h⁻¹) or saline for 7 days. Daily tail-flick (TF) and intrathecal morphine challenge tests were performed to assess the effect of intrathecal ß-arrestin 2 siRNA on antinociception and tolerance to morphine. Naloxone withdrawal (2 mg kg⁻¹) was performed to assess morphine dependence. RESULTS: In the daily TF test, the antinociception of intrathecal morphine was increased and maintained in rats receiving ß-arrestin 2 siRNA compared with the control group (morphine alone). In the probe response test, rats receiving morphine infusion with ß-arrestin 2 siRNA treatment showed a significant left shift in their dose-response curve, as measured by per cent maximal possible effect (MPE), such that the AD50 was significantly decreased by a factor of 5.6 when compared with that of morphine-infused rats. In the naloxone-induced withdrawal tests, rats receiving ß-arrestin 2 siRNA injection with morphine infusion showed a significant reduction in four of the six signs of withdrawal. CONCLUSIONS: We show here that intrathecal ß-arrestin 2 siRNA in rats enhances analgesia and attenuates naloxone-induced withdrawal symptoms. This may warrant further investigation in the context of long-term use of intrathecal opioids for controlling chronic pain.

Retroperitoneal ectopic pancreas: imaging findings.

Ectopic pancreas is relatively uncommon and usually occurs in the stomach or duodenum. Retroperitoneal ectopic pancreas has not previously been documented. We report the case of a 48-year-old man with retroperitoneal ectopic pancreas that imitated bilateral adrenal tumours on ultrasound and MRI. Subsequent CT-guided biopsies confirmed an ectopic pancreas. The lesions remained stable during follow-up for 7 years. In retrospect, the similarity in signal intensities and enhancement pattern between the retroperitoneal masses and the pancreas may have been a clue to the diagnosis of this rare entity.

Association between single nucleotide polymorphisms of surfactant protein D and allergic rhinitis in Chinese patients.

The development of allergic rhinitis is considered to be determined by the interaction between genetic and environmental factors. Surfactant protein D (SP-D) has been proposed to offer protection against allergenic challenge at various levels in allergic responses. The present study aimed to investigate whether polymorphisms within the SFTPD gene (Met11Thr, Ala160Thr, and Ser270Thr) are associated with allergic rhinitis. Genotyping of SFTPD polymorphisms was performed using the pyrosequencing method. The study population comprised 216 patients with allergic rhinitis and 84 normal controls. The frequency of 11Thr/Thr genotype and Thr allele in the patient group was significantly higher than that in the control group after applying Bonferroni corrections (P = 0.007 and P = 0.006, respectively). Our subjects with the 11Thr/Thr genotype are more susceptible to allergic rhinitis. There were no significant differences between the patient group and the control group for frequencies of genotypes and alleles in either Ala160Thr or Ser270Thr single nucleotide polymorphisms (P > 0.05). No significant associations could be detected between any of these three SFTPD gene polymorphisms and the skin prick test response (P > 0.05). Meanwhile, there was a lack of association between the three loci and the levels of serum total immunoglobulin E (P > 0.05). In summary, our results suggest that the Met11Thr polymorphism in SP-D plays a major role in the genetic predisposition to allergic rhinitis in Chinese adult population, whereas the other two SP-D polymorphisms displayed no significant association with allergic rhinitis.

Efficacy of methylprednisolone, cyclophosphamide in pediatric IgA nephropathy assessed by renal biopsy.

AIMS: IgA nephropathy is one of the most common glomerular diseases in children. The aim of this study was to investigate the clinical and pathologic efficacy of methylprednisolone and cyclophosphamide in the treatment of primary pediatric IgA nephropathy. METHODS: 11 patients with renal-biopsy-diagnosed Grade IV IgA nephropathy were treated with methylprednisolone and cyclophosphamide. Pathological changes were evaluated by post-treatment renal biopsies. RESULTS: At follow-up (18 - 60 months post-treatment), 6 patients were in complete remission. For the remaining 5, treatment was rated "markedly effective." Renal biopsies showed less mesangial proliferation, significantly decreased crescent formation, reduced segmental sclerosis, and significantly reduced mesangial IgA deposition. CONCLUSIONS: Methylprednisolone and cyclophosphamide in children with Grade IV IgA nephropathy stabilized renal function and significantly reduced hematuria, proteinuria, mesangial IgA deposition, and the renal pathological activity index.

Expression of ubiquitin in peripheral inflammatory cells from patients with coronary artery disease.

In addition to its role in the removal of damaged and unneeded proteins, the ubiquitin-proteasome system (UPS) may play a key role in coronary artery disease (CAD). To investigate the expression of ubiquitin in monocytes and lymphocytes isolated from patients at different stages of CAD, 120 patients with CAD (40 with acute myocardial infarction [AMI], 40 with unstable angina pectoris [UAP] and 40 with stable angina pectoris [SAP]) were selected; 40 patients with normal coronary arteries served as controls. At both the mRNA and protein levels, ubiquitin expression was higher in patients with CAD than in controls, and patients with AMI had a much higher expression of ubiquitin (at both the mRNA and protein levels) than those with SAP and UAP. These data indicate that ubiquitin expression increased with increasing severity of CAD, suggesting that ubiquitin may play a critical role in the development and progression of CAD.

Effects of Bupleurum scorzoneraefolium, Bupleurum falcatum, and saponins on nephrotoxic serum nephritis in mice.

ETHNOPHARMACOLOGICAL SIGNIFICANCE: Bupleuri radix is a commonly prescribed Oriental herbal medicine containing extracts of different Bupleuri species. We wished to determine whether two of these species, Bupleurum scorzoneraefolium and Bupleurum falcatum, or their active ingredients, saikosaponins a, c, and d, could prevent the development of immune-complex nephritis in nephrotoxic serum treated mice. MATERIALS AND METHODS: Immune-complex nephritis was created in C57BL/6 mice by administration of nephrotoxic serum containing anti-basement membrane antibodies. Mice were next given one of five treatments: Bupleurum scorzoneraefolium, Bupleurum falcatum, saikosaponin a, saikosaponin c, or saikosaponin d. Proteinuria, blood urea nitrogen, creatinine, and renal histological changes were then examined. RESULTS: Saikosaponin c almost completely prevented the development of nephritis, although immune-complex deposition was not affected. Bupleurum falcatum and saikosaponin d had a significant, although lesser effect, and Bupleurum falcatum and saikosaponin a showed no effect. CONCLUSIONS: The mechanism of action of saikosaponin c and the reasons for the difference between the two bupleuri species should be investigated further in order to find the best way to utilize the therapeutic effect of Bupleuri radix on nephritis.

Development of malignant lymphoma subsequent to breast cancer.

The development of malignant lymphoma following breast cancer has not been described before. Here we report the development of malignant lymphoma at the ipsilateral chest wall subsequent to the surgical treatment of breast cancer. A 48-year-old woman underwent modified radical mastectomy due to breast carcinoma. Tamoxifen (10 mg twice daily) was given 3 years after the operation and continued for about 3 years. The patient was well until she recently (17 years after the initial operation) noted a small lump at her left anterior chest wall near the axilla. The local tumour mass was initially assumed to be a local recurrent lesion of breast cancer. Excisional biopsy was performed and eventually was histologically diagnosed to be malignant lymphoma. In view of the therapeutic implication, the development of second malignancy should not be mistaken as a progression of the known primary malignancy. Only with the awareness of such entity, can the prompt diagnosis and proper treatment be achieved.

Levels and value of platelet activity in patients with severe internal carotid artery stenosis.

BACKGROUND: Turbulent blood flow caused by arterial stenosis can induce platelet activation and aggregation, which subsequently participate in arterial thromboembolic events. OBJECTIVE: To test the hypothesis that platelet activation (expressed by CD62p) is enhanced in cerebral vs systemic circulation in patients with severe internal carotid artery (ICA) stenosis. METHODS: Platelet CD62p expression was prospectively measured using flow cytometry in 35 consecutive symptomatic patients with severe ICA stenosis and in 20 at-risk control subjects who underwent both coronary and cerebral angiographic studies due to angina pectoris and suspicious vertebral artery or intracranial artery stenosis. The CD62p expression was also evaluated in 20 healthy subjects. Blood samples were first drawn from the right internal jugular vein (cerebral circulation) and right femoral vein (systemic circulation) before extra- and intracerebral angiographic examination of both patients and at-risk control subjects and again at 40 minutes after ICA stenting. Clopidogrel was administered to the patients following the second blood sampling. RESULTS: Systemic CD62p expression was higher in patients than in both the healthy and at-risk control subjects (both p < 0.0001). Additionally, cerebral CD62p expression was higher in patients than in at-risk control subjects (p < 0.0001) prior to intervention. Moreover, CD62p expression was higher in cerebral circulation than in systemic circulation in the patients (p < 0.0001) before ICA stenting. However, CD62p expression was less enhanced in cerebral circulation than in systemic circulation after ICA stenting (p < 0.0001). Furthermore, CD62p expression was decreased after 3 months of follow-up (p < 0.0001). CONCLUSIONS: Compared to systemic CD62p expression, cerebral CD62p expression was more enhanced prior to ICA stenting and was less enhanced after ICA stenting in patients with severe ICA stenosis.

Effect of 2-month detraining on body composition and insulin sensitivity in young female dancers.

OBJECTIVE: To investigate the effect of 2-month detraining on body composition and glucose tolerance for female collegiate dancers. DESIGN: Longitudinal study of dancers who stopped their regular training for 2 months. SUBJECTS: 16 female collegiate dancers (age: 19.7 +/-0.11 year, body mass index (BMI): 20.7 +/- 0.56 kg/m(2)). MEASUREMENTS: BMI, waist-to-hip ratio (WHR), oral glucose tolerance test (OGTT), insulin response during OGTT, and blood lipids at baseline and after a 2-month detraining. RESULTS: Glucose tolerance was not significantly affected by the detraining, but the fasted insulin and insulin levels during OGTT were significantly elevated. Fasted free fatty acid (FFA) and triglyceride levels were significantly elevated without change in cholesterol level. BMI was not significantly altered during this detraining period, but the waist circumference and WHR ratio were significantly elevated. CONCLUSION: Only a 2-month cessation of regular training in female dancers significantly elevated basal and postprandial insulin levels and triglycerides, and were associated with increased basal FFA. This result appears to be partly related to the increased central fatness but not body mass, indicating that the early development of obesity due to reduced physical activity may not necessarily reflect on weight status. A warning is thus warranted for those young women who depend on weight measurement for body fat status monitoring.

Serum levels of soluble E-selectin in women with breast cancer.

BACKGROUND: Increasing evidence suggests that E-selectin contributes to tumour growth and metastasis, possibly by increasing angiogenesis and the adhesion of tumour cells to endothelial cells at distant sites. This study aimed to examine the relationship between preoperative levels of circulating soluble E-selectin and breast cancer. METHODS: Sixty-four consecutive women undergoing surgery for invasive breast cancer were studied prospectively. Venous blood samples were collected before the operation. A control group consisted of 16 patients with a benign breast tumour (eight with fibrocystic disease and eight with fibroadenoma). Serum concentrations of soluble E-selectin were measured by the quantitative sandwich enzyme immunoassay technique and compared with clinicopathological information. RESULTS: The mean (s.d.) serum level of soluble E-selectin in patients with invasive breast cancer was 73.7 (20.9) ng/ml, compared with 36.3 (5.6) ng/ml in the control group (P < 0.001). Furthermore, the serum levels of soluble E-selectin were significantly higher in women with oestrogen receptor-negative tumours (P = 0.001), poorly differentiated tumours (P < 0.001), more advanced primary tumour stage (P < 0.001), involved lymph nodes (P < 0.001), distant metastases (P < 0.001) and more advanced tumour node metastasis (TNM) stage (P < 0.001). On multivariate analysis, TNM stage (P < 0.001) was found to be an independent factor with regard to higher serum levels of soluble E-selectin. CONCLUSION: Preoperative serum levels of soluble E-selectin might reflect the severity of invasive breast cancer; further evaluation is warranted.

Temporal and spatial expression of bone morphogenetic proteins in extracorporeal shock wave-promoted healing of segmental defect.

Extracorporeal shock wave (ESW) is a noninvasive acoustic wave, which has recently been demonstrated to promote bone repair. The actual healing mechanism triggered by ESW has not yet been identified. Bone morphogenetic proteins (BMP) have been implicated as playing an important role in bone development and fracture healing. In this study, we aimed to examine the involvement of BMP-2, BMP-3, BMP-4, and BMP-7 expression in ESW promotion of fracture healing. Rats with a 5-mm segmental femoral defect were given ESW treatment using 500 impulses at 0.16 mJ/mm(2). Femurs and calluses were subjected to immunohistochemistry and RT-PCR assay 1, 2, 4, and 8 weeks after treatment. Histological observation demonstrated that fractured femurs received ESW treatment underwent intensive mesenchymal cell aggregation, hypertrophic chondrogenesis, and endochondral/intramembrane ossification, resulting in the healing of segmental defect. Aggregated mesenchymal cells at the defect, chondrocytes at the hypertrophic cartilage, and osteoblasts adjunct to newly formed woven bone showed intensive proliferating cell nuclear antigen expression. ESW treatment significantly promoted BMP-2, BMP-3, BMP-4, and BMP-7 mRNA expression of callus as determined by RT-PCR, and BMP immunoreactivity appeared throughout the bone regeneration period. Mesenchymal cells and immature chondrocytes showed intensive BMP-2, BMP-3, and BMP-4 immunoreactivity. BMP-7 expression was evident on osteoblasts located at endochondral ossification junction. Our findings suggest that BMP play an important role in signaling ESW-activated cell proliferation and bone regeneration of segmental defect.

Muscle force, motor nerve conduction velocity and compound muscle action potentials after parathyroidectomy for secondary hyperparathyroidism.

OBJECTIVE: We studied the motor nerve conduction velocity (MNCV) and the amplitude of compound muscle action potentials (CMAP) in patients with symptomatic secondary hyperparathyroidism at preoperative and 3 months post-operative period, to find the factors affecting muscle force after parathyroidectomy. METHODS: Twenty-six patients with symptomatic secondary hyperparathyroidism with levels of intact parathyroid hormone (iPTH) over 6.8 pmol/l who underwent total parathyroidectomy and autotransplantation of 60 mg of tissue were included in this research. Extension force of the quadriceps muscle was measured at 60 degrees of right knee flexion and expressed as Newtons (N) in peak force and average force. Nerve conduction studies of four limbs were checked and the MNCV and CMAP of right femoral and tibial nerves were analyzed and correlated with the muscle force. RESULTS: Three months after operation, the peak force increased from 272 +/-108 to 315 +/- 123 N (P=0.015) and the average force from 215 +/- 94 to 253 +/- 103 N (P=0.006). MNCV and latencies of femoral and tibial nerves did not show definite change, but the amplitude of CMAP increased significantly from 7.1 +/- 4.1 to 10.7 +/- 3.2 mV (P=0.005) at femoral stimulation and from 9.8 +/- 4.6 to 11.7 +/- 4.3 (P=0.007) and 13.2 +/- 5.9 to 14.9 +/- 6.0 (P=0.011) at proximal and distal tibial stimulation. CONCLUSION: The improvement of muscle force after surgery was found to be parallel to the increment of the amplitude of CMAP but not to nerve conduction velocity or latency. We propose that the weakness of the patients with secondary hyperparathyroidism is probably related to alteration of muscle fiber contraction.

[A comparative study on aging between Taipei City and Taiwan's rural areas].

"This paper extends research on the difference in ageing factors between Taipei City and Taiwan's rural area in terms of the changes in fertility, mortality, and migration rates.... The analysis--based on data collected from 1968-1993 demographic data in Taiwan-Fukien Demographic Fact Book...provides strong evidence that population processes (fertility, mortality, and migration) have different influences on the population ageing of Tapei City and Taiwan's rural area." (SUMMARY IN ENG)