Anatomical variations and developmental insights of tendons in the first extensor compartment of the hand: Cadaveric study with surgical implications.

Background: Anatomical variations in first extensor compartment play a role in the development of de Quervain's disease. This study delves into the detailed examination of these anatomical variations. Methods: 50 upper limbs (28 male and 22 female) from 25 for-malin-embalmed adult human cadavers were dissected to investigate variations in tendons of first extensor compartment. Results: Accessory tendons to main tendon of abductor pollicis longus (APL) were reported in 49 (98%) cases, with 34% having two accessory tendons, 52% having three, and 12% having four. Terminal ends of these accessory tendons were generally consistent, except in one case where it split into two tendinous bands at insertion site, which was most commonly at base of first metacarpal. Extensor pollicis brevis (EPB) was found as a single tendon in 48 cases, with one case each of duplication and absence. In 19 cases (38%), muscle belly of EPB was fused with that of APL to some extent and it typically inserted at base of the proximal phalanx of the thumb. Average length of muscle belly, tendon, and muscle tendon ratio (MTR) of APL was 15.99±0.62 cm, 5.91±0.76 cm and 2.71 and of EPB was 6.39±0.29 cm, 9.15±0.74 cm and 0.70 respectively. Conclusion: APL variations range from accessory tendons, splitting of tendons to various insertion points. Additionally, length and insertions points of these accessory tendons are key factors in deciding their usability as graft sources for tendon reconstruction and in surgical treatments of conditions like de Quervain's tenosynovitis.

QSAR analysis for 6-arylpyrazine-2-carboxamides as Trypanosoma brucei inhibitors.

Human African trypanosomiasis (HAT) is prevalent in African countries, covering 37 countries, mostly sub-Saharan. A limited number of drugs are available to cure this neglected disease. In the present work, quantitative structure-activity (toxicity) relationships (QSA(T)R) analysis has been performed for a dataset of 54 6-arylpyrazine-2-carboxamides as Trypanosoma brucei inhibitors to identify the important structural features required for future optimization of lead candidates. The QSA(T)R models satisfy OECD guidelines and have high statistical robustness. The QSA(T)R models are based on easily interpretable molecular descriptors. The QSA(T)R models indicate that Trypanosoma brucei inhibitory activity of 6-arylpyrazine-2-carboxamides has correlation with the presence of N-sec-butylformamide and substituted benzene. The results could be beneficial for further optimization of 6-arylpyrazine-2-carboxamides as Trypanosoma brucei inhibitors. Some potential candidate molecules have been proposed.

Hepatitis B immunity in Australia: a comparison of national and prisoner population serosurveys.

In Australia, hepatitis B (HBV) vaccination is recommended for injecting drug users (IDUs), Indigenous adults and prisoners. We compared immunity to HBV in prisoners and the general population obtained from national serosurveys in 2007. Individuals with HBV surface antibody (HBsAb) positive sera were considered immune from past infection [HBV core antibody (HBcAb) positive] or from vaccination (HBcAb negative). Male prisoners aged 18-58 years had a higher HBsAb seroprevalence than the general population (46·4% vs. 39·4%, P = 0·061). Comparison of HBcAb results was possible for males aged 18-29 years. In this group, higher HBsAb seroprevalence was due to past infection (12·9% vs. 3·0%, P < 0·001), rather than vaccine-conferred immunity (35·3% vs. 43·4%, P = 0·097). All prisoner groups, but especially IDUs, those of Indigenous heritage or those with a previous episode of imprisonment had higher levels of immunity from past infection than the general population (19·3%, 33·0%, 17·1%, respectively, vs. 3·0%, P < 0·05). Indigenous prisoners, non-IDUs and first-time entrants had significantly lower levels of vaccine-conferred immunity than the general population (26·4%, 26·2% and 20·7% respectively vs. 43·4%, P < 0·05). Improving prison-based HBV vaccination would prevent transmission in the prison setting and protect vulnerable members of the community who are at high risk of both infection and entering the prison system.

Cor triloculare biatriatum--A case report.

Cor triloculare biatriatum or double inlet single ventricle is a congenital heart defect in which both atria are connected to a common or dominant ventricle. The present report presents an index case and describes the embryological basis and clinical aspects of this extremely rare anomaly. A three months old infant presented with extreme respiratory distress without cyanosis and repeated chest infections. The patient was diagnosed to be a case of single ventricle with both atria opening in the common ventricular chamber. The common ventricular chamber (single ventricle) was connected to a rudimentary outflow tract. The great arteries were in a position of d-transposition of great arteries. However, there was no pulmonary or aortic stenosis. A clear concept and awareness regarding this condition and its clinical manifestations is bound to facilitate timely intervention with improved success rates.

Correlation of bone mineral density with biochemical markers in post menopausal women.

To evaluate the magnitude of bone loss in postmenopausal women and to study the effect of a selective estrogen Receptor Modulator, raloxifene, on bone loss by quantitative ultrasound of calcaneus and serum bone specific alkaline phosphatase (BAP). Postmenopausal women with ostesopenia/osteoporosis were assigned randomly to receive placebo (n=30) or raloxifene (60mg/d, n=30) with calcium (500mg/day) and vitamin D (250 IU/day). The bone mineral density (BMD) and BAP levels were measured at the beginning of therapy and six months later. They were subjected to statistical analysis (t test, p value) using SPSS statistical package. 70% of postmenopausal women suffered from osteopenia/osteoporosis. After raloxifene therapy, there was improvement in the BMD but this was not statistically significant (p>0.05). There was a fall in the value of serum BAP by 26.6% (p<0.05). Raloxifene has a favourable effect on bone turnover as evident from changes in BMD and a significant fall in serum BAP.

Ex vivo programmed macrophages ameliorate experimental chronic inflammatory renal disease.

Macrophage infiltration of the kidney is a prominent feature associated with the severity of renal injury and progressive renal failure. To determine the influence of macrophages in renal disease models in the absence of endogenous T and B cells, we performed adoptive transfer of macrophages into severe combined immunodeficient (SCID) mice. In this study, macrophages were isolated from the spleens of BALB/c mice and stimulated with lipopolysaccharide to induce classically activated M1 macrophages or with interleukin-4 (IL-4) and IL-13 to induce alternatively activated M2 macrophages. These macrophages were then infused into SCID mice with adriamycin nephropathy; an in vivo model of chronic inflammatory renal disease analogous to human focal segmental glomerulosclerosis. Mice infused with M1 macrophages had a more severe histological and functional injury, whereas M2 macrophage-induced transfused mice had reduced histological and functional injury. Both M1 and M2 macrophages localized preferentially to the area of injury and maintained their phenotypes even after 4 weeks. The protective effect of M2 macrophages was associated with reduced accumulation and possibly downregulated chemokine and inflammatory cytokine expression of the host infiltrating macrophages. Our findings demonstrate that macrophages not only act as effectors of immune injury but can be induced to provide protection against immune injury.

Risk factors for coronary heart disease in two similar Indian population groups, one residing in India, and the other in Sydney, Australia.

OBJECTIVE: To identify the prevalence of coronary risk factors among South Asian Indians in Australia and India. DESIGN: Cross-sectional intercountry comparison. SUBJECTS: Healthy volunteers aged 23-75 y recruited from the Indian community in Sydney Australia (n=125), and their nominated relatives in India, (n=125). RESULTS: The two groups were of similar background with over 90% of the group in India being siblings, parents or relatives of the group in Australia. There was no difference in the populations between India and Australia with regard to mean age (40+/-11.5 vs 39+/-10.3 y), body mass index (BMI) (25+/-3.3 vs 25+/-3.5 kg/m(2)), lipoprotein (a) (178 vs 202 mg/l), total cholesterol (5.3+/-1.3 vs 5.3+/-1.2 mmol/l) or triglyceride (1.7+/-0.8 vs 1.7+/-0.8 mmol/l). The group in India had higher insulin (median values) (139 vs 83 pmol/l, P=0.0001), waist-to-hip ratio (WHR) (0.88+/-0.08 vs 0.85+/-0.09, P=0.01), exercise time (23.7+/-32.7 vs 17.2+/-23.2 h/week, P=0.07), lower waist (83+/-10.0 vs 85+/-11.1 cm, P=0.05) and high-density lipoprotein (0.9+/-0.3 vs 1.1+/-0.6 mmol/l, P=0.02). Women in India had lower BMI (22.7+/-2.9 vs 25.3+/-4.2 kg/m(2), P<0.001), higher insulin (182 vs 90 pmol/l, P<0.001), WHR (0.86+/-0.08 vs 0.77+/-0.06, P<0.001)) and prevalence of abdominal obesity (% WHR >0.8, 73 vs 23%, P<0.001; odds of waist >90 cm=2.3, P<0.05). Men in India had the same BMI, lower waist (85.5+/-8.8 vs 92.9+/-7.2 cm, P<0.001) and WHR (0.89+/-0.09 vs 0.93+/-0.05, P<0.01) but higher insulin (137 vs 76 pmol/l). CONCLUSION: The group in Australia (especially women) have a more favourable disease risk profile than those in India. The fact that the groups are of such similar background and partly related, make it unlikely that changes due to migration have a strong genetic bias. In contrast to other studies, the absence here of excessive weight gain on migration may be a key factor in disease risk prevention.

Dietary fat up-regulates the apolipoprotein E mRNA level in the Zucker lean rat brain.

High-fat diet alters apo E-dependent processing of beta-amyloid precursor protein. Here we have evaluated the effects of dietary fat on brain apo E mRNA in Zucker lean and obese rats. After approximately 2 months on a high-fat diet, there was significant up-regulation of brain apo E mRNA in the Zucker lean rat in parallel with weight gain. Densitometric quantification revealed a 17% increase in apo E mRNA in the brains of lean rats fed high-fat diet compared with those of lean rats fed rat chow. No significant difference in brain apo E mRNA of Zucker obese rats fed different diets was found. These results suggest that dietary fat alters brain apo E levels, which may be regulated, in part, through the leptin receptor.

Low-density lipoprotein subclasses in children under 10 years of age.

OBJECTIVE: To examine the prevalence of small dense low density lipoprotein (LDL) in a cohort of children under 10 years of age and to investigate the relationship to other biochemical variables and to measures of fatness. A preponderance of small dense LDL (pattern B), is associated with obesity, abdominal fat accumulation, insulin resistance and risk of heart disease in adults. METHODOLOGY: LDL peak particle diameter (PPD) was determined by gel electrophoresis in 53 children under 10 years of age and in 65 of their parents: apoproteins A1 and B were determined by turbidimetry. Anthropometric variables, basic lipid profiles, insulin and leptin had been determined previously. Differences between patterns A (large light particles > 25.5 nm diameter) and B were examined by t-test, Chi-square, or Mann-Whitney test. Relationships between the variables were reported as Pearson correlation coefficients. RESULTS: Pattern B (PPD of < or = 25.5 nm) prevalence was 7.5% in children and 11% in parents (17% in men and 5% in women). Most of the children (86%) who had PPD < or = 26.0 nm also had parents with PPD in this range. A strong association was found between children's and mother's PPD (r=0.60, P < 0.001), but this was somewhat less with fathers (r=0.40, P=0.02). Children in the lowest tertile of PPD had a tendency towards a higher body mass index, waist, fat mass and insulin. CONCLUSIONS: The prevalence of small dense LDL is lower in children under 10 years of age than in their parents; fathers had a higher prevalence of pattern B than mothers and there is some evidence of a familial effect in the inheritance of pattern B.

A collectin-like protein from tunicates.

Collectins are a sub-family of C-type lectins from mammals and birds that are characterized by their collagen-like domains. The mammalian collectin, mannose binding lectin, has attracted considerable interest because it can activate complement components via a lectin-mediated complement pathway that is independent of immunoglobulins. In this study, we have identified a calcium-dependent lectin from the invertebrate (tunicate), Styela plicata, that bears substantial similarities to mammalian collectins. The tunicate lectin, which was isolated by carbohydrate affinity chromatography, has a reduced apparent molecular mass of 43 kDa. The 43 kDa reduced polypeptide appeared as dimers, trimers and hexamers when analyzed by non-reducing and two-dimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis, while gel filtration suggested that the native form of the protein was a nonamer. Amino acid sequence and amino acid composition analysis revealed obvious similarities between the tunicate lectin and mammalian collectins, notably the inclusion of a collagenous domain and a short, cysteine bearing N-terminal domain. The identification of a collectin-like protein in an invertebrate such as S. plicata, which does not express immunoglobulin, indicates that lectin-mediated complement pathways may predate the origin of antibodies.

Cardiovascular risk factors in elderly Koreans in Australia and Korea.

Koreans are a recent but relatively small ethnic minority group in Australia. This descriptive cross-sectional, comparative intercountry study examines the effect of Australian acculturation among elderly Koreans on cardiovascular disease (CVD) risk factors, compared with their counterparts in Korea. Fifty-one (72.4 ± 8.7 years) Australian Koreans (AK) and 48 (75.7 ± 6.9 years) Koreans (K) living in Seoul participated in the study. Diabetes was reported by 10.2% of AK and 17.4% of K and hypertension by 38.8 and 29.8% of AK and K, respectively. Significantly, more AK (85.7%) than K (53.2%) reported undertaking physical activity (P = 0.0005) and fewer AK were current smokers (6% vs 26.1%; P = 0.0077). After controlling for age, body mass index and waist-to-hip ratio no differences were found in lipid profiles between AK and K men or women. The effect of acculturation may be reflected among Australian Koreans by increased physical activity and reduced smoking levels and increased levels of abdominal obesity.

Regular non-vigorous physical activity and cholesterol levels in the elderly.

BACKGROUND: High-density lipoprotein cholesterol (HDL-C) is a powerful independent risk factor for coronary heart disease (CHD) among the elderly. Regular vigorous physical activity has been found to raise the concentration of HDL-C and thus reduce the risk of CHD. There is little data on the effect of non-vigorous activity on HDL-C in the elderly. OBJECTIVE: The aim of this study was to compare CHD risk factors, especially HDL-C, in a group of elderly persons who engage in regular non-vigorous physical activity with a group of frail elderly examined in a previous study. METHODS: Each subject (51 women and 19 men) had anthropometric measures taken and completed a questionnaire on lifestyle and medical history. Total cholesterol (TC), HDL-C and lipoprotein (a) were analysed. Results were compared with those of a frail group examined previously using similar methodology. RESULTS: HDL-C, adjusted for age, body mass index (BMI) and waist-to-hip ratio (WHR), was greater among women (p < 0.01) and men (p < 0.05) who were engaged in a regular physical activity at least once a week. TC was higher among active women (p < 0.001), but there was also a trend towards a lower TC/HDL ratio. Therefore, although TC is higher in active women, this could be due to a higher proportion of the cholesterol fraction consisting of HDL-C. WHR was negatively associated with HDL-C in frail men (p < 0. 05), active men (p < 0.01) and active women (p < 0.05). BMI was negatively associated with HDL-C in frail women (p < 0.05). CONCLUSIONS: This sample of elderly people who participate in regular weekly non-vigorous physical activity have a higher HDL-C than frail individuals who do little or no exercise. Since HDL-C is consistently reported to be inversely associated with CHD in the elderly, an elevation in HDL-C concentration may provide some protection to elderly persons who participate in regular nonvigorous physical activity compared to frail elderly individuals who are largely sedentary. Caution should be exercised in the interpretation of a TC only reading in active elderly women without an accompanying measure of HDL.

Mifepristone (RU486): a review.

OBJECTIVE: To review the literature concerning the mechanism of action and pharmacodynamics of mifepristone (RU486), potential new uses of RU486, and its current use not only as an abortifacient but also as therapy for endometriosis, leiomyoma, breast cancer, and meningioma. DATA IDENTIFICATION AND SELECTION: Studies that relate to RU486 were identified through a MEDLINE search. CONCLUSION(S): RU486 is an 11 beta-dimethyl-amino-phenyl derivative of norethindrone with a high affinity for P and glucocorticoid receptors. The receptor binding is not followed by transcription of P-dependent genes. Mifepristone effectively blocks P receptors in the placenta, resulting in the termination of pregnancy. In addition, it has been used in the treatment of leiomyomata, endometriosis, advanced breast cancer, and meningioma. It is a powerful tool to study the molecular action of P and in the future may be used as an estrogen-free contraceptive.

PIP: Through an online search of MEDLINE, the authors reviewed the literature on the development of mifepristone (RU-486); RU-486's mechanism of action, pharmacodynamics, and distribution; the physiologic action of RU-486; potential new uses for RU-486; and its current use as both an abortifacient and therapy for endometriosis, leiomyoma, breast cancer, and meningioma. RU-486 is an 11beta-dimethyl-amino-phenyl derivative of norethindrone with a high affinity for P and glucocorticoid receptors. Receptor binding is not followed by the transcription of P-dependent genes. RU-486 effectively blocks P receptors in the placenta, resulting in the termination of pregnancy. It has also been used to treat leiomyomata, endometriosis, advanced breast cancer, and meningioma. The following therapeutic uses of RU-486 are discussed: the termination of early pregnancy, treatment with RU-486 in combination with prostaglandins, the termination of second-trimester pregnancy, cervical ripening, labor induction, postcoital contraception, uterine leiomyomata, endometriosis, breast cancer, and meningioma.

Hormonal modulation of the vaginal bacterial flora in experimental polycystic ovarian disease.

Rats exposed to constant light develop polycystic ovarian (PCO) disease with persistent estrus, representing an estrogen-dominant condition. Herein, we report that fluctuations seen in the vaginal microflora in cyclic rats were not observed in PCO rats with persistent estrus. The vaginal-cervical mucosa of PCO rats showed numerous adherent bacteria by scanning electron microscopy, similar to that seen in proestrus and estrus rats, but unlike the diestrus rats in which fewer organisms adhered to the mucosa. Administration of human chorionic gonadotropin induced ovulation in PCO rats, which was associated with a significant decrease in serum estradiol, an increase in progesterone, and a significant decrease in the estradiol/progesterone ratio compared with baseline values (P < 0.01). This also resulted in an influx of leukocytes in the vagina with a significant decrease in vaginal anaerobic as well as aerobic bacterial flora. These data demonstrate that loss of cyclic ovarian activity in PCO rats with persistent estrus causes increased bacterial colonization of the vaginal-cervical mucosa, and the ovarian hormones appear to modulate the colonization of bacteria in the lower genital tract.

Effect of obesity on the clinical and hormonal characteristics of the polycystic ovary syndrome.

The polycystic ovary (PCO) syndrome is frequently associated with obesity. That subset of women reportedly shows a much higher incidence of hirsutism and menstrual irregularities than do nonobese women with PCO syndrome. We evaluated the clinical features and hormonal profiles of 56 women with PCO syndrome and correlated them with the presence or absence of obesity. Thirty-eight (67.8%) of these women were obese (body mass index > or = 25 kg/m2). While presenting with the classic manifestations of PCO, they did not differ significantly from the manifestations of nonobese women with PCO syndrome. Although obese women with PCO had a lower incidence of oligomenorrhea as compared to nonobese women with PCO (57.9% vs. 83.3%, respectively) and amenorrhea was more frequent in the former group (42.1% vs. 16.6%, respectively), these findings are not statistically significant. The incidences of hirsutism and anovulatory infertility in the obese group as compared to the nonobese group were 81.6% vs. 77.8% and 28.9% vs. 27.8%, respectively (not statistically significantly different). The mean (+/- SE) serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), LH/FSH ratios, prolactin and testosterone were not statistically significantly different among the two groups. The present study found that obesity is common in PCO syndrome but that there are no significant differences in the clinical and hormonal characteristics of obese and nonobese women with it. Further studies are warranted to clarify the impact of obesity on clinical, metabolic and hormonal changes in PCO syndrome.