Association of use of Chinese herbal medicines and the risk of fracture in patients with osteoporosis: a population-based cohort study.

After utilizing a large population-based claims database and the application of propensity score match approach to reduce the confounding effects, we found that the use of Chinese herbal medicines (CHMs) was related to the lower risk of sequent osteoporotic fracture by 27% among the individuals with osteoporosis. The predominant effect was observed in those receiving CHMs for more than two years. INTRODUCTION: Osteoporosis (OS) is a highly disabling condition that can lead to fragility fracture, thus posing greater burdens of functional limitations for the affected individuals. It is unclear if the use of Chinese herbal medicines (CHMs) could reduce the risk of fracture due to OS. This study aimed to investigate the association of CHMs and the subsequent osteoporotic fracture risk among OS patients. METHODS: This longitudinal cohort study used the Taiwanese National Health Insurance Research Database to identify 250,699 newly diagnosed OS patients aged 20 years or older between 1998 and 2010. We recruited 103,325 CHM users following the onset of OS (CHM users) and randomly selected 103,325 subjects without CHM usage as controls (non-CHM users) by propensity score matching according to the demographic characteristics and comorbidities at enrollment. All enrollees were followed until the end of 2012 to record the incidence of osteoporotic fracture. We applied the Cox proportional hazard regression model to compute the hazard ratio (HR) of the risk of osteoporotic fracture. RESULTS: During the 15-year follow-up period, 7208 CHM users and 11,453 non-CHM users sustained osteoporotic fracture, with an incidence rate of 9.26 and 12.96, respectively, per 1000 person-years. We found that CHM users had a significantly reduced risk of osteoporotic fracture compared to non-CHM users (adjusted HR 0.73; 95% confidence interval [CI] = 0.70-0.75). Those treated with CHMs for longer than 730 days had a lower fracture risk by 54%. Some commonly used CHMs, such as Yan hu suo (Rhizoma Corydalis), Huang Qin (Scutellaria Baicale), Jie Geng (Platycodon grandifloras), Xiang Fu (Cyperus rotundus), Hai Piao Xiao (Cuttlebone Sepium), Jia-Wei-Xiao-Yao-San, Ge-Gen-Tang, Shao-Yao-Gan-Cao-Tang, and Du-Huo-Ji-Sheng-Tang, are related to the lower risk of fracture. CONCLUSIONS: The use of CHMs was associated with lower risk of osteoporotic fracture for OS patients, suggesting that it could be integrated into conventional therapy to prevent subsequent bone fracture.

Effects of stimulus intensity on latency and conduction time of short-latency somatosensory evoked potentials.

We studied the effect of stimulus intensity on latencies of short-latency somatosensory evoked potentials (SSEP) by measuring both onset and peak latencies individually. The latencies of N9, N13, N20 and N9-N13 peripheral conduction time (PCT) of median nerve (MN) SSEP, and N8, N23, P37 and N8-N23 PCT of tibial nerve (TN) and sural nerve (SN) SSEP significantly shortened with increasing stimulus intensity by onset latency measurement. However, those latencies by peak latency measurement were less significantly shortened or had only a trend of latency shortening without statistical significance. In contrast to PCT, N13-N20 central conduction time (CCT) of MN-SSEP and N23-P37 CCT of TN- or SN-SSEP showed no latency changes with the increased stimulus intensity by both onset and peak latencies measurement. As peak latencies had greater interindividual variability than onset latencies shown by larger standard deviation, shortening of onset latencies were more consistent than that of peak latencies. We think shortening of onset latencies indicates the recruitment of faster conduction fiber along with increased stimulus intensity. As the degree of latency shortening was less if stimulus intensity was above 2.5 times sensory threshold, the stimulus intensity greater than 2.5 times the sensory threshold should be used for clinical application.

Improved discrete fractional Fourier transform.

The fractional Fourier transform is a useful mathematical operation that generalizes the well-known continuous Fourier transform. Several discrete fractional Fourier transforms (DFRFT's) have been developed, but their results do not match those of the continuous case. We propose a new DFRFT. This improved DFRFT provides transforms similar to those of the continuous fractional Fourier transform and also retains the rotation properties.

The effects of stimulus rates upon median, ulnar and radial nerve somatosensory evoked potentials.

We examined the effect of stimulus rates on the somatosensory evoked potential (SEP) amplitude following stimulation of the median nerve (MN) and the ulnar nerve (UN) at the elbow or wrist, and the radial nerve (RN) at the wrist in 12 normal subjects. We measured the amplitude of frontal (P14-N18-P22-N30) and parietal peaks (P14-N20-P26-N34) at a stimulus rate of 1.1, 3.5 and 5.7 Hz. The amplitude attenuation was found at frontal P22 and N30 and to a lesser degree at parietal N20 and P26 peaks with an increasing stimulus rate from 1.1 to 5.7 Hz. The amplitude attenuation was greatest at the elbow when compared to the wrist stimulation for both MN and UN. The attenuation was least for wrist stimulation for the RN. The UN block by local anesthesia just distal to the stimulus electrode at the elbow abolished the amplitude attenuation caused by the fast stimulus rate. The observed amplitude attenuation with the faster stimulus rate is probably due, in part, to interference from the "secondary" afferent inputs. The secondary afferent inputs arise from peripheral receptor stimulation (muscle, joint and/or cutaneous) as a subsequent effect of efferent volleys initiated from the point of stimulation. The greater number of peripheral receptors being activated as more proximal sites of stimulation in a mixed nerve would result in greater attenuation of the SEP recorded from scalp electrodes. We postulate that the attenuation of frontal peaks by the fast stimulus rate is due to the frontal projection of interfering "secondary" afferent inputs.

Actions of a long-acting somatostatin analog SMS201-995 (sandostatin) on rat locus coeruleus neurons.

The actions of sandostatin involving rat locus coeruleus (LC) neurons were examined using an intracellular recording in a brain slice preparation. Bath application of sandostatin (5-100nM) reversibly decreased the firing rate of all neurons tested in a dose-dependent manner. Sandostatin was 9.5 times more potent than somatostatin in light of an inhibition of the spontaneous firing rate. In addition to the inhibition of spontaneous firing, larger concentrations of sandostatin (30-100nM) also hyperpolarized the neurons of the locus coeruleus and simultaneously caused a reduction in input resistance. At the highest concentration (100nM) applied, sandostatin produced complete inhibition of firing of all neurons tested (n = 49); the inhibition was associated with a 11.6mV hyperpolarization (range 2.2-26.4 mV, n = 49) and a 21.8% reduction in input resistance (range 2.6-55.2%, n = 39). The voltage-current relationship of the resting cell revealed an inward-going rectification that became enhanced after the perfusion of sandostatin (100nM) for 5 min. The reversal potential for the sandostatin-induced hyperpolarization was -111 +/- 1 mV (n = 10), which is approximately the potassium equilibrium potential. This hyperpolarization was blocked by both caesium chloride and barium chloride. Our results also showed that sandostatin displayed an antagonistic action on mu opiate receptors. Both the somatostatin-agonistic and opiate-antagonistic activities of sandostatin were conclusively found to be stronger than those of somatostatin; in addition, the inhibitory actions of sandostatin on LC neurons were due to an opening of the inward-going rectification potassium channels.

Effects of somatostatin-28 on rat locus coeruleus neurons.

The effects of somatostatin-28 (SS-28) on rat locus coeruleus (LC) neurons were investigated with techniques of brain slice and intracellular recording. SS-28 was applied by micropressure ejection through a micropipette. SS-28 (500 microM, 10 or 20 psi, 1 msec - 5 sec) reversibly decreased the firing rate of all neurons of the locus coeruleus tested. In addition to inhibition of spontaneous firing, larger concentrations of SS-28 also hyperpolarized the neurons of the locus coeruleus and simultaneously decreased the input resistance. At the greatest concentration (20 psi x 5sec) applied, SS-28 produced complete inhibition of firing of all neurons tested; the inhibition was associated with a 11-mV hyperpolarization and decreased input resistance 9 percent. The voltage-current relationship of the resting cell revealed an inward-going rectification that became enhanced after the pressure application of SS-28. The reversal potential for the SS-28-induced hyperpolarization was -116 mV, which is approximately the potassium equilibrium potential. The results also showed that BaCl2 blocked the SS-28-induced hyperpolarization, but apamin did not. We conclude that the inhibitory actions of SS-28 are due to opening the inward-going rectification potassium channels and that SS-28 and somatostatin-14 exert similar electrophysiological actions on LC neurons.

Electrophysiological actions of alfentanil: intracellular studies in the rat locus coeruleus neurones.

1. The electrophysiological effects of alfentanil on 156 neurones of the rat locus coeruleus were investigated by use of intracellular recordings from the in vitro brain slice preparation. 2. Bath application of alfentanil (5-100 nM) reversibly decreased the firing rate of all neurones tested in a dose-dependent manner, with an IC50 4.1.nM. 3. Based on inhibition of the spontaneous firing rate, alfentanil was 22 times more potent than morphine. 4. At 100 nM, alfentanil produced a complete inhibition of firing of all neurones tested (n = 62); the inhibition was accompanied by a membrane hyperpolarization 17.0 +/- 0.8 mV (range 6.1-30.3 mV, n = 62) and a reduction in input resistance 26.4 +/- 1.7% (range 6.5-53%, n = 51). 5. The effects of alfentanil were antagonized by naloxone, with a dissociation equilibrium constant of 2.7 +/- 0.4 nM (n = 6). 6. The reversal potential for the alfentanil-induced hyperpolarization was -110 +/- 2 mV (n = 9), which is approximately the potassium equilibrium potential. 7. The alfentanil-induced hyperpolarization was blocked by caesium chloride and barium chloride. 8. These results indicate that alfentanil binds to mu-opioid receptors on the cell membrane of neurones of the locus coeruleus. This leads to opening of the inward-going rectification potassium channels, resulting in the observed hyperpolarization of the membrane.

[Neonatal bowel perforation successfully treated by conservative treatment: report of two cases].

Neonatal bowel perforation is a potentially lethal disease whose etiology and pathophysiology remain unclear. An aggressive approach with surgical intervention has been favored by some authors; otherwise, a high mortality rate was reported. In recent time, peritoneal drainage under local anesthesia for critically-ill premature infants with complicating perforation of necrotizing enterocolitis has had good results. Two cases of such perforation are reported. Case 1, a full-term baby was delivered by spontaneous delivery. Bowel perforation was found on the second day after birth. Case 2, a 27-week gestational age, premature baby, was delivered by emergent Cesarean section because of maternal placenta previa with massive vaginal bleeding. Bowel perforation was found, after feeding, on the seventh day after birth. Both sets of parents refused any surgical procedure, but the infants survived under medically conservative treatment, and the use of peritoneal drainage. This technique may be considered for neonates with bowel perforation if a surgical procedure is unsuitable or unacceptable.

[A study of serum phosphorus and renal phosphate excretion in children of different age groups].

To further elucidate the data of high serum phosphorus concentration reported for foreign children, this study compared the values of serum phosphorus concentration in ethnic Chinese children with foreigners' results, and investigated the potential causes of high serum phosphorus concentration. This study included 33 healthy term male neonates from 2-3 days to 5-7 days old, 1,094 children of 6-18 years old (elementary school-senior high school) and 62 adults. A total of 1,189 persons were studied. Value of serum phosphorus concentration showed no significant difference between boys and girls, and no age dependency; there was notable change in serum phosphorus concentration in growing children of different ages. The mean values of serum phosphorus concentration of neonates aged 2-3 days and 5-7 days (7.20 mg/dl and 7.65 mg/dl, respectively) were the highest; boys aged 6-11 years 5.15-5.50 mg/dl and girls aged 6-11 years 5.14-5.28 mg/dl were the second; boys aged 12-18 years 4.31-4.94 mg/dl and girls aged 12-18 years 4.44-4.96 mg/dl were the lowest. These findings are similar to the conclusions of foreign reports that the older the subjects of the study, the less their serum phosphorus concentration. The maximal transport rates of tubular phosphate reabsorption were determined from a Walton-Bijvoet nomogram using the side-rule method they recommend. The renal phosphate threshold concentration of neonates aged 2-3 days 8.41 mg/100 ml GFR and 5-7 days 7.76 mg/dl GFR was also the highest; boys aged 6-11 years 5.84-6.32 mg/dl GFR and girls aged 6-11 years 5.82-6.10 mg/dl GFR and 5.44-6.10 mg/dl GFR was the second; adult males 3.51 mg/dl GFR and adult females 3.62 mg/dl GFR was the lowest. Increased intestinal absorption of phosphorus, low GFR and low clearance of phosphorus might be the contributing factors to cause high serum phosphorus concentration. Although high renal phosphate threshold capacity is important, increased absorption of phosphorus by G-I tract seems to be another factor in accordance with the need of phosphorus of the growing body cells.

Results of 110 vitrectomies with a portable vitrectomy system.

We retrospectively evaluated the VITAC (vitreous-tissue aspiration cutter), a portable vitrectomy system with an end-cutting vitrectomy probe with a self-sharpening oscillating blade and a monoblock design, in 110 vitrectomy procedures, 34 performed at the University of California Davis Medical Center and 76 performed at the Eye and ENT Hospital in Shanghai, China. The indications for vitrectomy included penetrating injuries (22 eyes), intraocular foreign bodies (28 eyes), vitreous hemorrhages (18 eyes), cataracts (17 eyes), endophthalmitis (seven eyes), pupillary-block glaucoma (five eyes), bullous keratopathy (five eyes), aphakic penetrating keratoplasty (three eyes), pupillary membranes (two eyes), massive preretinal proliferation (one eye), and cystoid macular edema (one eye). Vitrectomy resulted in visual improvement in 19 of 34 eyes in the California series (56%) and in 60 of the 76 eyes in the Shanghai series (79%). This difference was attributable to the higher percentages of cases involving the posterior segment and vitreous hemorrhage in the California series. When results from both institutions were combined, surgery with the VITAC produced visual improvement in 79 of 110 cases (72%), comparable to the results obtained with other vitrectomy systems.