Liver anatomy, intrahepatic vascular and biliary branching system of the mole rat (Spalax leucodon).

BACKGROUND: There are many studies on the morphology of the liver and its blood vessels in experimental animals, but such studies are lacking in the mole rat (Spalax leucodon). The aim of this paper was a detailed basic study on the topography, morphology, vascular and biliary branching systems of the liver in the mole rat. MATERIALS AND METHODS: Coloured gelatine and mixture of coloured lead oxide and linseed oil were injection contrast masses used to obtain vascular and biliary branching pattern in the liver. It was revealed that the liver of the mole rat had five lobes (left, quadrate, right medial, right lateral and caudate lobes). RESULTS: The left, undivided lobe was the largest lobe of the liver. The quadrate lobe was divided into two components by a deep notch. The gallbladder, of cylindrical shape, was present and attached to the quadrate lobe. The common bile duct was formed by the union of the left and right hepatic ducts. The pancreatic duct joined the common bile duct before it entered the duodenum. In the present study, only the right medial lobe and quadrate lobe always showed a single lobar artery, portal and hepatic veins. The left lobe showed four lobar arteries, portal and hepatic veins. The caudate lobe with its two processes and the right lateral and medial lobes had different arterial and portal blood supply as well as hepatic and biliary drainage of these lobes. The intrahepatic branches of the proper hepatic artery ran parallel to the branches of the common portal vein in the same lobes of the liver. CONCLUSIONS: The results of this study are significant for comparative studies among different species of rodents and other experimental animals. Morphology, vasculature and biliary tract of the liver in the mole rat were similar to that of other experimental animals and identified differences may be related to the adaptation to the mode of life and diet of this rodent.

Epithelial discrimination of commensal and pathogenic Candida albicans.

All mucosal surfaces are lined by epithelial cells and are colonised by opportunistic microbes. In health, these opportunistic microbes remain commensal and are tolerated by the immune system. However, when the correct environmental conditions arise, these microbes can become pathogenic and need to be controlled or cleared by the immune system to prevent disease. The mechanisms that enable epithelial cells to initiate the 'danger' signals activated specifically by pathogenic microbes are critical to mucosal defence and homeostasis but are not well understood. Deciphering these mechanisms will provide essential understanding to how mucosal tissues maintain health and activate immunity, as well as how pathogens promote disease. This review focuses on the interaction of the human fungal pathogen Candida albicans with epithelial cells and the epithelial mechanisms that enable mucosal tissues to discriminate between the commensal and pathogenic state of this medically important fungus.

Statin use and clinical osteoarthritis in the general population: a longitudinal study.

BACKGROUND: One hypothesis has posited whether abnormal lipid metabolism might be a causal factor in the pathogenesis of osteoarthritis (OA). Routine statin use in clinical practice provides the basis for a natural experiment in testing this hypothesis. OBJECTIVE: To test the hypothesis that statins reduce the long-term occurrence of clinically defined OA. DESIGN: Cohort design with a 10-year follow-up. PARTICIPANTS: 16,609 adults cardiovascular disease cohorts aged 40 years and over from the UK General Practice Research Database with data available to 31 December 2006. INTERVENTION: Statins were summarised as annual mean daily dose and dose change over two-year time periods. MAIN MEASURES: Incident episode of clinically defined osteoarthritis was assessed within 2 years, and at 4-year and 10-year follow-up time periods, using Cox and discrete time survival analysis. Covariates included age, gender, deprivation, body mass index, cholesterol level, pain-modifying drug co-therapies, and duration and severity of cardiovascular disease. KEY RESULTS: Higher therapeutic dose of statin, with a treatment duration of at least 2 years was associated with a significant reduction in clinical OA compared to non-statin users in the follow-up time period. The estimated adjusted rate ratios were as follows: lowest statin dose quartile 1: 2.5 (95 % CI 2.3, 2.9); quartile 2: 1.3 (1.1, 1.5); quartile 3: 0.8 (0.7, 0.95); and highest statin dose quartile 4: 0.4 (0.3, 0.5). The largest statin dose increments were associated with significant reductions estimated at 18 % in OA outcome within 2 years and 40 % after 4 years, compared to non-statin users. CONCLUSIONS: This longitudinal study from a national clinical practice setting provides evidence that higher statin dose and larger statin dose increments were associated with a reduction in clinically defined OA outcome.

The spontaneous resolution of heavy menstrual bleeding in the perimenopausal years.

OBJECTIVE: To obtain estimates of the rate of spontaneous resolution of heavy menstrual bleeding and to explore any association with specific menstrual symptoms. DESIGN: Two-year prospective cohort study. SETTING: Seven general practices, with 67 100 registered patients. POPULATION: All women aged 40-54 years on the practices age-sex registers. METHODS: Baseline postal questionnaire, with follow-up questionnaires sent to naturally menstruating respondents at 6, 12, 18 and 24 months. MAIN OUTCOME MEASURES: Rate of spontaneous resolution of heavy menstrual bleeding in naturally menstruating women. RESULTS: A total of 7121 baseline questionnaires were sent out, with an initial response rate of 63%. We recruited 2051 naturally menstruating women for the prospective cohort study. The spontaneous rate of resolution of heavy menstrual bleeding varied from 8.1% (95% CI 5.3-12%) in women aged 45-49 years, who had resolution without recurrence for 24 months, to 35% (95% CI 30-41%) in women aged 50-54 years, who had resolution without recurrence for 6 months. Rates were lower in those who reported interference with life from heavy menstrual bleeding. There was a strong association between the spontaneous resolution of heavy menstrual bleeding and skipped periods in women aged over 45 years. The association with 'cycle too variable to say' was significant, but weaker. CONCLUSION: There is a high prevalence, incidence and significant spontaneous rate of resolution of heavy menstrual bleeding in naturally menstruating women during the perimenopausal years. The rates have potential use for individual women, clinical decisions, devising and implementing interventions and planning the care of populations.

Risk factors for cardiovascular disease and future osteoarthritis-related arthroplasty: a population-based cohort study in men and women from Malmö, Sweden.

OBJECTIVE: To investigate the hypothesis that cardiovascular risk factors increase the likelihood of future osteoarthritis (OA)-related arthroplasty in adult men and women. METHODS: Baseline cohort data on cardiovascular risk factors [age, socio-economic class, family history, obesity, smoking, glucose, cholesterol, blood pressure, and early cardiovascular disease (CVD) history] were linked to clinical registers of OA-related arthroplasty data. The study included 8749 women and 14 821 men with up to a 30-year follow-up. RESULTS: In women, higher cardiovascular risk groups were more likely to have an OA outcome compared to the lowest risk quartile group (trend p < 0.001). The estimates were as follows: second quartile risk: rate ratio (RR) 2.15, 95% confidence interval (CI) 1.6-2.9, third quartile risk: 3.32 (2.5-4.5); and highest risk quartile: 3.47 (2.6-4.7). In men, higher cardiovascular risk groups were also more likely to have an OA outcome compared to the lowest risk quartile group (trend p = 0.001). The estimates were as follows: second quartile risk: RR 1.44, 95% CI 1.1-1.9; third quartile risk: 1.38 (1.1-1.8); and highest risk quartile: 1.67 (1.3-2.2). CONCLUSIONS: Our large cohort study with up to a 30-year follow-up period provides evidence to support the hypothesis of shared risk factors in CVD and OA, and the findings suggest an alternative aetiological process in the pathogenesis of OA.

Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis.

OBJECTIVE: Knee osteoarthritis (OA) is common in older adults. Determination of risk factors for onset of knee OA may help in its prevention. The objective of this systematic review, and meta-analysis, was to determine the current evidence on risk factors for knee OA. DESIGN: A systematic literature search was carried out for cohort and case-control studies evaluating the association of demographic, comorbid, and other patient-determined factors with onset of knee OA. A scoring tool was developed to assess the quality of studies. Heterogeneity of studies was examined. Where possible studies were pooled to give an overall estimate of the association of factors with onset of knee OA. RESULTS: Of the 2233 studies screened, 85 were eventually included in the review. Study quality tended to be moderate. The main factors consistently associated with knee OA were obesity (pooled OR 2.63, 95% CI 2.28-3.05), previous knee trauma (pooled OR 3.86, 95% CI 2.61-5.70), hand OA (pooled OR 1.49, 95% CI 1.05-2.10), female gender (pooled OR 1.84 95% CI 1.32-2.55) and older age. Smoking appeared to have a moderate protective effect, however this was not evident once the analysis was restricted to cohort studies only. CONCLUSIONS: Whilst certain factors have been extensively reviewed (for example, body mass index), more longitudinal studies are needed to investigate the association of physical occupational and other patient-determined factors with future knee OA. The quality of such studies also needs to be improved. However, there are identifiable factors which can be targeted for prevention of disabling knee pain.

Physiological predictors of maximum treadmill walking performance in patients with intermittent claudication.

The purpose of this investigation was to identify physiological predictors of maximum treadmill walking performance (MWD) in patients with intermittent claudication. Forty-five claudicants performed a graded treadmill test to determine MWD, peak oxygen uptake, and gas exchange threshold. Calf muscle oxygenation (StO (2)) at 1 min and time to minimum StO (2) were also measured using near-infrared spectroscopy. On other occasions, peak calf blood flow, resting ankle-brachial index, and pulmonary oxygen uptake kinetics during steady-state walking were assessed. A forward stepwise multiple regression analysis was performed to determine predictors of MWD. A regression model comprising time to minimum StO (2), peak oxygen uptake, and StO (2) at 1 min explained 64% of the variation in MWD. The results suggest that cardiopulmonary fitness and the ability to match oxygen delivery to metabolic demand are important determinants of walking performance in claudicants, and that certain near-infrared spectroscopy variables might be useful in studies that evaluate the mechanisms of clinical improvement with different treatment interventions.

The influence of consulting primary care on knee pain in older people: a prospective cohort study.

OBJECTIVE: To investigate whether consulting a general practicioner (GP) in the 3 years after reporting knee pain is linked to better knee pain outcomes (reduced presence or severity of knee pain) at the end of the 3 year period. METHODS: We undertook a population-based cohort study linking baseline (2000) and follow-up (2003) surveys to primary care medical records. The cohort comprised 1577 adults aged 50 and over registered at 3 general practices in North Staffordshire, UK, who reported knee pain in a baseline survey. The main outcome measures were self-reported prevalence of knee pain and severity of knee pain in the follow-up survey. The relationship between consultation and future knee pain status was adjusted for an individual's propensity to consult given related demographic and health-related factors. RESULTS: In persons who consulted for knee pain, 91% reported knee pain at 3 years, compared with 73% of those who did not consult (adjusted odds ratio (OR) 2.25; 95% CI 1.56 to 3.26). Among persons reporting severe knee pain or disability at baseline (n=669), those who consulted for knee pain were more likely to report severe knee pain or disability at 3 years than those who did not consult (82% v 65%, adjusted OR 1.93; 95% CI 1.27 to 2.93). CONCLUSIONS: Older adults with knee pain continue to have persistent problems regardless of whether they consult primary care or not. Further research is needed to identify more effective means of reducing the burden of knee pain in the community.

Predictors of onset and progression of knee pain in adults living in the community. A prospective study.

OBJECTIVE: To investigate determinants of the onset and progression of knee pain in a population-based sample of people aged > or = 50 yrs. METHODS: Prospective cohort study of 2982 people registered with three general practices in North Staffordshire, UK. Using questionnaire surveys at baseline and 3 yrs, demographic, knee-related and general health factors were assessed for their relationship with onset of new knee pain, and progression from non-severe to severe knee pain. RESULTS: Response rates were 77% (baseline) and 75% (follow-up). Baseline factors significantly associated with onset of knee pain were knee injury [odds ratio (OR) 1.6, 95% CI 1.2, 2.2], depression (OR 1.4, 95% CI 1.1, 1.8), widespread pain (OR 1.5, 95% CI 1.1, 1.9 compared with no pain) and younger age. Onset of severe knee pain was associated most strongly with obesity (OR 2.9, 95% CI 1.7, 5.1) and physical limitations (OR 2.5, 95% CI 1.5, 4.1), and with widespread pain, older age, female gender and comorbidity. The strongest independent predictors of progression from non-severe to severe knee pain were chronicity (OR 3.1, 95% CI 2.1, 4.6), previous use of health care (OR 2.2, 95% CI 1.5, 3.3) and obesity (OR 2.1, 95% CI 1.2, 3.6). CONCLUSION: In addition to a focus on obesity, there is potential for primary prevention of knee pain by tackling knee injuries and treating depression. Other factors are likely to determine whether the knee pain then progresses. An area for future research is the ineffectiveness of current health care in halting or reversing progression of knee pain at a population level.

[Evaluation of the efficacy of electroconvulsive therapy in the treatment of delusional, congruently delusional and non-congruently delusional subtypes of unipolar affective disorders]. / Procena efikasnosti elektrokonvulzivne terapije u lecenju nesumanutog, sumanutog kongruentnog i sumanutog nekongruentnog podtipa unipolarnog afektivnog poremecaja.

In this retrospective pilot study we tried to find out whether there were any differences in therapeutic response to electroconvulsive therapy in the patients with diagnosed unipolar affective disorder due to the presence and type of delusions in the clinical course of the disease. The sample consists of 45 inpatient unipolar depressives, 15 male and 30 female, divided into 3 experimental groups: nondelusional depressions, depressions with congruent delusions and depressions with incongruent delusions. Two variables were used to estimate the therapeutic response: number of received ECT treatments and proportion of full remissions. Our results showed significant differences between all the groups for both variables with the best therapeutic response in the group of incongruent delusional depressions and the worst in the group of nondelusional depressions.