Sternoclavicular Septic Arthritis and Surgical Intervention: A Case Report.

Management of septic arthritis is an area of controversy, especially in rare locations like the sternoclavicular joints. In this case report, we present a case of septic sternoclavicular joint, which was resistant to medical treatment and deteriorated during the treatment course. Although medical treatment has proven effective based on previous literature, some cases will still not benefit from it. In this case, our patient responded significantly to surgical treatment regarding upper limb function, faster infection eradication and rehabilitation, and shorter hospitalization and antibiotics duration.

Outcome of a conservatively treated large Pipkin I fracture dislocation: a case report.

Pipkin I fracture dislocation is a rare injury. They commonly present following high mechanism trauma with possible devastating complications regardless of the treatment option. Treatment consensus depends on fracture reduction, size, site, and displacement. Surgical management is reserved for large fragments. We present a 42-year-old female presented with multiple chest injuries and left sided Pipkin I fracture dislocation Two days following the trauma. The fracture was found to be vertical in nature and was managed by closed reduction and a period of bed rest and skeletal traction. She was followed over a 3-year period and showed satisfactory results. We believe that the vertical nature of the fracture and maintenance of the anatomic reduction led to her successful outcome.

One-Year Mortality Rates Following Fragility Femoral Fractures in Patients Presenting to King Saud Medical City in Riyadh, Saudi Arabia: A Retrospective Study.

OBJECTIVE: The objective is to investigate one-year mortality rates following femur osteoporotic fractures, and to investigate factors that are associated with higher mortality rates. DESIGN: A retrospective study was conducted from 2010 to 2021 (11 years) of all patients who presented to King Saud Medical City, Saudi Arabia, and had a fragility fracture of the proximal or distal femur. PATIENTS: One hundred eight patients who sustained a proximal or distal femoral fracture, as a result of low-energy trauma, were included. RESULTS: The majority of our cohort (77.8%) had proximal femoral fractures, whereas only 22.2% had a distal femoral fracture. 55.6% were less than 75 years old, and 44.4% were 75 years or older. All patients had fallen from standing height. Hypertension and diabetes were the most common comorbidities among our cohort at 49.1% and 47.2%, respectively, but neither showed a statistically significant increase in the risk of mortality. When assessing the overall mortality, 21.3% of our patients had passed away. Although this finding was not statistically significant, mortality rates were found to be higher in patients with proximal femoral fractures compared to distal femoral fractures (25% vs. 8.3%, respectively, p=0.095). Patients with a normal bone mass density (BMD) had higher mortality rates as opposed to those with abnormal BMD (p=0.001). CONCLUSIONS: Mortality rates are higher in proximal femoral fractures compared to distal femoral fractures. In addition, within our study cohort, patients with normal BMD had higher mortality rates. We recommend prospective studies that compare mortality rates between proximal and distal femoral fractures in patients with osteoporosis, as these studies would provide more accurate data. We also recommend having BMD measured in those patients to avoid further fractures in this patient population.

Bilateral Lisfranc Injury in a Young Female: A Case Report.

Lisfranc injuries are relatively rare, accounting for only 0.2% of all injuries. It is even rarer to have this injury bilaterally, and not many case reports have been published on this topic. In this report, we present a case of a bilateral Lisfranc injury in a healthy 17-year-old woman that fell from a flight of stairs landing on both feet. The diagnosis was made by weight-bearing x-rays and computed tomography. Weight-bearing x-rays showed a subtle Lisfranc injury in the right foot with widening between the first and second rays and a disruption involving the overlapping bases of the lesser metatarsals as well as a left comminuted fracture of the proximal third and fourth metatarsals (MT) with intra-articular extension at the proximal fourth MT. CT scan of the right foot showed a fracture of the lateral margin of the medial cuneiform with a displaced bony fragment as well as a comminuted fracture of the third and fourth metatarsals with intra-articular extension and no dislocation. Surgical management, in the form of open reduction and internal fixation, was undertaken for both feet in the same setting. She had an expected course postoperatively and has been doing well, with no pain nor limitation in her activity at her six-month postoperative visit. Moreover, we present a brief review of similar published cases and an overview of Lisfranc injuries.

Characteristics and outcomes of hip fractures in lower limb amputees.

INTRODUCTION: Lower limb amputees, regardless of age are at an increased risk of developing fragility fractures of the neck of femur. The characteristics and outcomes of the fractures of the neck of femur in lower limb amputees have not been studied in detail. METHODS: We undertook a retrospective review of a prospectively collected single centre and single surgeon database between March 1996 and January 2017, using a standard proforma to identify patients who required surgical intervention for fracture neck of femur and had sustained a previous lower limb amputation and compared them with a cohort of standard hip fracture patients. RESULTS: Twenty-seven patients, sustaining 28 fractures of the neck of femurs were identified of which 16 were females with mean age of 78 years (50-89). Nineteen fractures were sustained on the ipsilateral side of the amputation. Results showed that seventy percent of amputees returned to their previous level of mobility and prior residence. Mortality in this group is higher as compared to a standard hip fracture patient but pain and mobility were comparable in both groups. DISCUSSION: The incidence of both hip fractures and amputations in increasing worldwide but no study has compared outcomes of hip fractures in amputees and compared them to a standard hip fracture patient. Amputees exhibit reduced bone density both at the hip and stump end which increases risk for osteoporosis and fragility fractures in the hip. The management of our patients followed orthopaedic principles, well established surgical interventions and rehabilitation. CONCLUSION: This study reveals that hip fractures in amputees can have comparable results to a standard hip fracture cohort if preoperative optimisation, planning and postoperative rehabilitation is carried out.

Evaluation of miR-196a2 expression and Annexin A1 level in children with bronchial asthmaEvaluation of miR-196a2 expression and Annexin A1 level in children.

BACKGROUND: Annexin A1 (ANXA1) is an important anti-inflammatory mediator that may play a significant role in bronchial asthma. MiR-196a2 can target ANXA1 and therefore may play a role in the pathogenesis of asthma. AIM OF STUDY: This is the first study which aimed to evaluate the expression of miR-196a2 in the serum of asthmatic children and correlate its expression with ANXA1 serum level and asthma severity. SUBJECTS AND METHODS: The study included 100 asthma patients who were subdivided into three groups (mild, moderate and severe) and 50 healthy control subjects. Assessment of miR-196a2 expression and ANXA1 serum level were done using quantitative reverse transcriptase PCR (RT qPCR) and Elisa techniques, respectively. RESULTS: Compared to the control group, asthmatic children showed an increased ANXA1 serum level and decreased expression of miR-196a2 (p=0.001). However, ANXA1 serum level was lower and miR-196a2 expression was higher in severe asthmatic patients compared to moderate asthmatic ones (p=0.01, 0.03). Pearson's correlation coefficient revealed no significant correlations between ANXA1 serum level and miR-196a2 expression in the patient group (p=0.9). CONCLUSIONS: Altered miR-196a2 expression and serum ANXA1 concentration may play a role in the pathogenesis of asthma. In addition, ANXA1 and miR-196a2 may represent potential diagnostic biomarkers for asthma and future targets for therapy.

The role of social network, social support, religiosity and depression among elderly Malaysians who had experienced major life events.

BACKGROUND: Research has found that social network, social support and religiosity are associated with depression in elderly people. However, these predictors of depression have not been fully explored among the high risk elderly population. This study aims to examine the prevalence and factors associated with depression among Malaysian elderly subjects who had experienced major life events. METHODS: This is a cross-section study of a subsample of 594 participants from the original sample of 2322 Malaysian elderly respondents, who had experienced major life events. Information on socio-demographic, social network, social support, religiosity and depression were collected through an interviewer-administered questionnaire. A multiple linear regression analysis was used to determine the factors associated with depression among elderly who experienced major life events. RESULTS: Overall prevalence of depression among subsample of Malaysian elderly facing major life events was 9.4%. The results showed that age (p≤0.01), income (p≤0.001) and social network (p≤0.05) were significant associated with depression. In other words, with increasing age, low income as well as small social network associated with high risk of developing depression among elderly who had experienced major life events CONCLUSION: Other than age and income, social network were also associated with depression among elderly respondents who had experienced major life events. Therefore, professionals who are working with elderly with major life events should seek ways to enhance elderly networking as one of the strategies to prevent depression.

Piezoelectric Biomaterials for Sensors and Actuators.

Recent advances in materials, manufacturing, biotechnology, and microelectromechanical systems (MEMS) have fostered many exciting biosensors and bioactuators that are based on biocompatible piezoelectric materials. These biodevices can be safely integrated with biological systems for applications such as sensing biological forces, stimulating tissue growth and healing, as well as diagnosing medical problems. Herein, the principles, applications, future opportunities, and challenges of piezoelectric biomaterials for medical uses are reviewed thoroughly. Modern piezoelectric biosensors/bioactuators are developed with new materials and advanced methods in microfabrication/encapsulation to avoid the toxicity of conventional lead-based piezoelectric materials. Intriguingly, some piezoelectric materials are biodegradable in nature, which eliminates the need for invasive implant extraction. Together, these advancements in the field of piezoelectric materials and microsystems can spark a new age in the field of medicine.

Ictal autonomic activity recorded via wearable-sensors plus machine learning can discriminate epileptic and psychogenic nonepileptic seizures.

Differentiating epileptic seizures (ES) and psychogenic nonepileptic seizures (PNES) is commonly based on electroencephalogram and concurrent video recordings (vEEG). Here, we demonstrate that these two types of seizures can be discriminated based on signals related to autonomic nervous system activity recorded via wearable sensors. We used Empatica E4 Wristband sensors worn on both arms in vEEG confirmed seizures, and machine learning methods to train classifiers, specifically, extreme gradient boosting (XGBoost). Classification performance achieved a predictive accuracy of 78 ± 1.5% on previously unseen data for whether a seizure was epileptic or psychogenic, which is 6 standard deviations above the baseline of 68% accuracy. Our dataset contained altogether 35 seizures from 18 patients out of which 8 patients had 13 convulsive seizures. Prediction of seizure type was based on simple features derived from the segments of autonomic activity measurements (electrodermal activity, body temperature, blood volume pulse, and heart rate) and forearm acceleration. Features related to heart rate and electrodermal activity were ranked as the top predictors in XGBoost classifiers. We found that patients with PNES had a higher ictal heart rate and electrodermal activity than patients with ES. In contrast to existing published studies of mainly convulsive seizures, our classifier focuses on autonomic signals to differentiate convulsive or nonconvulsive semiology ES from PNES. Our results show that autonomic activity recorded via wearable sensors provides promising signals for detection and discrimination of psychogenic and epileptic seizures, but more work is necessary to improve the predictive power of the model.

The Role of Character Strengths in Depression: A Structural Equation Model.

The main aim of present study was to develop a model that specifies the predictive effects of some character strengths in depression. Two hundred individuals with major depression were recruited from clinical psychology centers. Participants completed a battery of questionnaires measuring dysfunctional attitudes, basic emotions, character strengths, and depression. Seven character strengths of critical thinking, emotional intelligence, gratitude, forgiveness, hope, spirituality, and zest were selected to measure the latent variable of character strengths. Structural equation modeling was used to analyze the data. Normed chi-square, comparative fit index, incremental fit index, and other indices demonstrated an adequate fit for the model suggesting that character strengths had an indirect effect on depression through the mediation of dysfunctional attitudes, negative affect, and happiness. Character strengths had negative effects on dysfunctional attitudes and positive effects on happiness. The findings of present study have implications for practitioners and researchers to develop an integrative model for the treatment of depression.

Urinary bisphenol A concentrations in relation to asthma in a sample of Egyptian children.

BACKGROUND: Bronchial asthma is one of the top disabling diseases in pediatrics. Limited research has been studied the association of the widely used plastic monomer bisphenol A (BPA) with childhood asthma. OBJECTIVE: To compare the levels of urinary BPA in asthmatic and control children and to investigate the implication of BPA among other risk factors for the development of asthma. SUBJECTS AND METHODS: This case-control study included 97 children (45 asthmatic and 52 healthy controls) aged 3-8 years. Asthmatic children were diagnosed according to Global initiative for asthma (GINA) guidelines. Sociodemographic factors were assessed and urinary levels of BPA were determined in spot urine samples using high-performance liquid chromatography. The contribution of BPA among predictors for developing asthma was studied in asthmatic children. RESULTS: Median total urinary BPA levels were significantly higher in asthmatic children than in control group (1.56 ng/mL in asthmatic children compared to 0.790 ng/mL in control group, p = 0.001). Children who had total urinary BPA levels >1.3 ng/mL were more likely to be asthmatic (odds ratio: 2.84, 95% confidence interval 1.22-6.59, p = 0.015). Multiple logistic regression analysis for predictors of asthma showed the importance of higher levels of BPA (>1.3 ng/mL) as a more significant predictor than passive smoking ( p = 0.006 for BPA categories vs. p = 0.049 for passive smoking). CONCLUSION: Association of higher levels of urinary BPA with the diagnosis of asthma in children may indicate the potential risk of BPA exposure in the precipitation of bronchial asthma. Further clinical and biochemical research are needed to clarify the proper mechanism explaining this association.

Patterned Plasmonic Surfaces-Theory, Fabrication, and Applications in Biosensing.

Low-profile patterned plasmonic surfaces are synergized with a broad class of silicon microstructures to greatly enhance near-field nanoscale imaging, sensing, and energy harvesting coupled with far-field free-space detection. This concept has a clear impact on several key areas of interest for the MEMS community, including but not limited to ultra-compact microsystems for sensitive detection of small number of target molecules, and "surface" devices for optical data storage, micro-imaging and displaying. In this paper, we review the current state-of-the-art in plasmonic theory as well as derive design guidance for plasmonic integration with microsystems, fabrication techniques, and selected applications in biosensing, including refractive-index based label-free biosensing, plasmonic integrated lab-on-chip systems, plasmonic near-field scanning optical microscopy and plasmonics on-chip systems for cellular imaging. This paradigm enables low-profile conformal surfaces on microdevices, rather than bulk material or coatings, which provide clear advantages for physical, chemical and biological-related sensing, imaging, and light harvesting, in addition to easier realization, enhanced flexibility, and tunability.

Tunable plasmonic substrates with ultrahigh Q-factor resonances.

Precisely tailored plasmonic substrates can provide a platform for a variety of enhanced plasmonic applications in sensing and imaging. Despite the significant advances made in plasmonics, most plasmonic devices suffer critically from intrinsic absorption losses at optical frequencies, fatally restricting their efficiency. Here, we describe and engineer plasmonic substrates based on metal-insulator-metal (MIM) plasmon resonances with ultra-sharp optical transmission responses. Due to their sharp transmission spectrum, the proposed substrates can be utilized for high quality (Q)-factor multi-functional plasmonic applications. Analytical and numerical methods are exploited to investigate the optical properties of the substrates. The optical response of the substrate can be tuned by adjusting the periodicity of the nanograting patterned on the substrate. Fabricated substrates present Q-factors as high as ∼40 and refractive index sensing of the surrounding medium as high as 1245 nm/RIU. Our results indicate that by engineering the substrate geometry, the dielectric thickness and incident angle, the radiation losses can be greatly diminished, thus enabling the design of plasmonic substrates with large Q factor and strong sensitivity to the environment.

Factors Related to Urinary Incontinence among the Malaysian Elderly.

BACKGROUND: Urinary incontinence is a prevalent condition in the elderly that is the spontaneous leakage of urine. It is an age-related problem and increases especially in people aged above 65 years. It can cause many psychological, behavioral, biological, economic and social effects. The treatment of urinary incontinence can reduce morbidity and mortality. Thus, this study aimed to determine the effects of variables including age, ethnicity, gender, education, marital status, body weight, blood elements and nutritional parameters on urinary incontinence among the Malaysian elderly. METHODS: The study was on 2322 non-institutionalized Malaysian elderly. The hierarchy logistic regression analysis was applied to estimate the risk of independent variables for urinary incontinence among respondents. RESULTS: The findings indicated that approximately 3.80% of subjects had urinary incontinence. In addition, constipation was found a significant factor that increased the risk of urinary incontinence in samples (p=0.006; OR=3.77). The increase in dietary monounsaturated fat (p=0.038; OR=0.59) and plasma triglyceride levels (p=0.029; OR=0.56) significantly reduced the risk of incontinence in subjects. Many of suspected variables including socio-demographic factors, diseases, nutritional minerals, blood components and body weight were non-relevant factors to urinary incontinence in respondents. CONCLUSIONS: Constipation increased the risk of urinary incontinence in subjects, and increase in dietary monounsaturated fat and plasma triglyceride levels decreased the risk.

Effect of supplementing broiler chicken diets with green tea extract on the growth performance, lipid profile, antioxidant status and immune response.

A trial was conducted to explore the effect of feeding graded concentrations of green tea extract (GTE; 125, 250, 500, 1000 and 2000 mg/kg) on the growth performance, serum lipid profile, liver glutathione-reduced, thigh muscle malondialdehyde and humoral immune response against Newcastle disease virus vaccines of broiler chickens from hatching to 42 d of age. The results of broilers fed on GTE were contrasted to those fed on butylated hydroxytoluene (BHT; 125 mg/kg) or unsupplemented controls. The obtained results revealed no significant difference among treatments in the measured growth performance parameters (body weight, average daily gain, average daily feed intake and feed conversion ratio), per cent liveability and serum lipid profile (total lipid, total cholesterol, high-density, low-density and very low-density lipoprotein cholesterols). Dietary intake of GTE resulted in a significant increase in the liver glutathione-reduced level compared to the control. The glutathione-reduced level of broilers fed on the BHT diet was not significantly different from that of broilers fed on GTE or control diets. Feeding GTE or BHT resulted in a significant decrease in the malondialdehyde level of meat tissue. The specific antibody titre against Newcastle disease virus vaccines was significantly increased at 28 and 35 d of age in broilers fed on diets supplemented with GTE but not with BHT. In conclusion, GTE was found to possess antioxidant and immunostimulant characteristics for broilers when supplemented to their diets, and its optimum inclusion level ranged from 125 to 500 mg/kg.

Efficient high-order analysis of bowtie nanoantennas using the locally corrected Nyström method.

It is demonstrated that the Locally Corrected Nyström (LCN) method is a versatile and numerically efficient computational method for the modeling of scattering from plasmonic bowtie nanoantennas. The LCN method is a high-order analysis method that can provide exponential convergence. It is straightforward to implement, accurate and computationally efficient. To the best of the author's knowledge, the high-order LCN is here applied for the first time to 3D nanostructures. Numerical results show the accuracy and efficiency of the LCN applied to the electromagnetic analysis of nanostructures.

Evaluation of a biosimilar recombinant alpha epoetin in the management of anemia in hemodialysis patients.

BACKGROUND: The efficacy of human recombinant erythropoietins (rHuEPOs) in the treatment of anemia with different etiologies is proven. Development of biosimilar rHuEPO products with lower cost and wider availability is important for the care of anemic patients. OBJECTIVE: The aim of the present study was to determine the bioequivalence and safety of a biosimilar rHuEPO (Pastopoitin(®)) and compare it with the innovator product Eprex(®), as a standard rHuEPO. METHODS: One hundred and seven anemic patients on stable hemodialysis were recruited to this randomized double-blind comparative trial and assigned to either subcutaneous Pastopoitin (n = 50) or Eprex (n = 57). Each study group received rHuEPO at a dose of 80-120 IU/kg/week in 2-3 divided doses for a period of 3 months. Hematologic parameters including Hemoglobin, hematocrit, RBC, EBC, platelet, MCV, MCH and MCHC were checked every 2 weeks. Blood iron, ferritin, TIBC, creatinine, BUN and electrolytes (Na, K, Ca and P) were evaluated monthly over the 3 months. RESULTS: A significant increase in hemoglobin, hematocrit and RBC was observed by the end of study in both Pastopoitin and Eprex groups (p < 0.001). However, these factors were not significantly different between the groups, neither at baseline nor at the end of study (p > 0.05). Likewise, the groups were comparable regarding MCV, MCH, MCHC, iron, ferritin, TIBC, creatinine, BUN and electrolytes at baseline as well as at the end of trial. Adverse events were not serious and occurred with the same frequency in the study groups. CONCLUSION: Pastopoitin showed comparable efficacy and safety profile with Eprex in anemic patients on hemodialysis. Hence, Pastopoitin may be considered as a rHuEPO with a lower cost and wider availability compared with the innovator product Eprex.

A randomized, double-blind, placebo-controlled study to evaluate the effects of alendronate on bone mineral density and bone remodelling in perimenopausal women with low bone mineral density.

BACKGROUND: Perimenopausal women can experience rapid bone loss at skeletal sites with both cortical and cancellous bone, increasing the prevalence of osteoporosis following menopause. METHODS: We conducted a 12-month randomized placebo-controlled trial evaluating the effects of alendronate 70 mg with 2800 IU cholecalciferol administered once per week for 12 months in comparison with placebo and cholecalciferol. The primary end-point was the percentage change in the lumbar spine bone mineral density (BMD) from baseline to 12 months. Secondary end-points were the change in BMD at the femoral neck and changes in biochemical markers of bone turnover. RESULTS: Forty-five women were recruited to participate in the study. Five subjects withdrew from the study before randomization for unrelated reasons. Forty subjects were randomly allocated to the alendronate and placebo groups. The mean lumbar spine MD in women treated with alendronate increased by 3.66% (mean paired difference, µd = 0.032; ± 0.008 SE) at 12 months, compared with a reduction of 3.33% (µd = -0.030; ± 0.008 SE) in the control group (P < 0.001). In the femoral neck, the mean BMD in the alendronate group increased by 2.07% (µd = 0.014; ± 0.009 SE) at 12 months, compared with a reduction of 1.87% (µd = -0.014; ± 0.008 SE) in the control group (P = 0.046). There were no differences in BMD between the alendronate and placebo groups at the total hip sites after 12 months. At 12 months, both bone-specific alkaline phosphatase and urinary N-telopeptide were significantly reduced, by 37.79% (µd = -9.90; ± 1.92 SE) and 27.21% (µd = -11.68; ± 4.80 SE) respectively, in the alendronate group; in the control group, these levels increased (P < 0.001). CONCLUSION: Weekly treatment with alendronate 70 mg and cholecalciferol 2800 IU increases BMD and decreases bone turnover in perimenopausal women.

Contexte : Les femmes périménopausées peuvent connaître une perte osseuse rapide aux points du squelette qui comptent des os tant corticaux que spongieux, ce qui accroît la prévalence de l'ostéoporose à la suite de la ménopause. Méthodes : Nous avons mené un essai comparatif randomisé avec placebo (d'une durée de 12 mois) qui cherchait à évaluer les effets de l'administration de 70 mg d'alendronate et de 2 800 UI de cholécalciférol (une fois par semaine, pendant 12 mois), par comparaison avec l'administration d'un placebo et de cholécalciférol. Le critère d'évaluation principal était la modification (en pourcentage, entre la valeur de départ et la valeur à 12 mois) de la densité minérale osseuse (DMO) de la colonne lombaire. Parmi les critères d'évaluation secondaires, on trouvait la modification de la DMO du col fémoral et les modifications des marqueurs biochimiques du renouvellement des cellules osseuses. Résultats : Nous avons sollicité la participation de 45 femmes à l'étude. Cinq participantes se sont désistées avant la randomisation pour des raisons n'ayant rien à voir avec l'étude. Quarante femmes ont été affectées au hasard à un groupe devant recevoir de l'alendronate ou à un groupe devant recevoir un placebo. Chez les femmes traitées à l'alendronate, la DMO moyenne de la colonne lombaire a connu une hausse de l'ordre de 3,66 % (différence moyenne appariée, µd = 0,032; ± 0,008 ET) à 12 mois, par comparaison avec une baisse de l'ordre de 3,33 % (µd = −0,030; ± 0,008 ET) au sein du groupe témoin (P < 0,001). Au niveau du col fémoral au sein du groupe « alendronate ¼, la DMO moyenne a connu une hausse de l'ordre de 2,07 % (µd = 0,014; ± 0,009 ET) à 12 mois, par comparaison avec une baisse de l'ordre de 1,87 % (µd = −0,014; ± 0,008 ET) au sein du groupe témoin (P = 0,046). Aucune différence en matière de DMO n'a été constatée entre les groupes « alendronate ¼ et « placebo ¼ pour ce qui est de l'ensemble des sites de la hanche après 12 mois. À 12 mois, tant la phosphatase alcaline propre aux os que le N-télopeptide urinaire ont connu une baisse significative, de l'ordre de 37,79 % (µd = −9,90; ± 1,92 ET) et de 27,21 % (µd = −11.68; ± 4,80 ET) respectivement, au sein du groupe « alendronate ¼; au sein du groupe témoin, les taux de ces marqueurs ont connu une hausse (P < 0,001). Conclusion : L'administration hebdomadaire d'un traitement faisant appel à 70 mg d'alendronate et à 2 800 UI de cholécalciférol entraîne une hausse de la DMO et une baisse du renouvellement des cellules osseuses chez les femmes périménopausées.

A phase 2 study of the combination of gemcitabine and cisplatin in patients with locally advanced or metastatic breast cancer previously treated with anthracyclines with/without taxanes.

BACKGROUND AND OBJECTIVES: Many patients with relapsed metastatic breast cancer are pre-treated with taxanes and anthracyclines, which are usually given in the neoadjuvant/adjuvant setting or as first-line treatment for metastatic disease. The primary objective of this study was to determine the overall response rate for combination treatment with gemcitabine and cisplatin in patients with locally advanced or metastatic breast cancer who had relapsed after receiving one adjuvant/neoadjuvant or first-line metastatic chemotherapy regimen containing an anthracycline with/without a taxane. Secondary endpoints included duration of response, time to progression, one-year survival probability, and toxicity. DESIGN AND SETTING: A single-arm, open-label, phase 2 study conducted at 17 investigative sites in Egypt. PATIENTS AND METHODS: treatment consisted of gemcitabine (1250 mg/m2) on Days 1 and 8 and cisplatin (70 mg/m2) on Day 1 of each 21-day cycle. Treatment continued until disease progression or a maximum of 6 cycles. RESULTS: Of 144 patients all were evaluable for safety and 132 patients were evaluable for efficacy. The overall response rate was 33.3% and 45.5% of the patients with stable disease as their best response. The median time-to-progression was 5.1 months and the one-year survival probability was 73%. The most common grade 3/4 adverse events were nausea/vomiting (20.1%), neutropenia (19.4%), anemia (13.9%), asthenia (11.1%), diarrhea (9.7%), stomatitis (7.6%), leucopenia (7.6%), and thrombocytopenia (6.2%). twelve (8.3%) patients had serious adverse events. CONCLUSIONS: The results of this study indicate that gemcitabine and cisplatin were active and generally well tolerated in pretreated patients with locally advanced or metastatic breast cancer.

Are Doppler ultrasonography parameters symmetric between the right and left kidney?

BACKGROUND: Among numerous modalities applied for evaluation of kidney diseases, Doppler ultrasonography (DU) provides information about the hemodynamic status of the kidneys. Meanwhile, the variability in DU parameters of the right and left kidney is a matter of controversy. The aim of this study was to determine whether any difference exists between the DU indices of the right and left kidney. METHODS: Retrospectively, we collected DU findings of 25 healthy potential renal transplant donors. All donors underwent renal DU and multidetector computed tomographic angiography before donor nephrectomy. DU indices, including peak systolic volume (PSV), resistive index (RI), pulsatility index (PI), end-diastolic volume (EDV), and acceleration time (AT), were recorded. RESULTS: The median age of the donors was 27 (range 23-39) years. The median PSV, RI, EDV, and AT for the right kidney were 29 cm/sec, 0.59, 10.9 cm/sec, and 50 msec, respectively. For the left kidney, the median PSV, RI, EDV, and AT were, respectively, 26.8 cm/sec, 0.60, 10.6 cm/sec, and 43 msec. Among the DU indices, median PI of the right kidney was significantly different from that of the left kidney (1.02 versus 0.95, P = 0.01). CONCLUSION: In conclusion, the present study revealed that right kidney DU indices, except for PI, may not differ from those of the left kidney.