Chang Gung medical journal最新文献

Background: This in vitro study investigated the angiogenesis and osteogenesis effects of shockwaves on bone marrow stromal cells (BMSCs) from hips with osteonecrosis.

Methods: BMSCs were harvested from the bone marrow cavity of the proximal femur in six patients with osteonecrosis of the femoral head. The specimens were divided into four groups, the control, shockwave, shockwave plus nω-nitro- L-arginine methyl ester (L-NAME) and a nitric oxide (NO) donor (NOC18) groups. The control group received no shockwaves and was used as the baseline. The shockwave group received 250 shockwave impulses at 14 Kv (equivalent to 0.18 mJ/mm2 energy flux density). The shockwave plus LNAME group was pre-treated with L-NAME before receiving shockwaves. The NOC18 group received NOC18 after cell culture for 48 hours. The evaluations included cell proliferation (MTT) assay, alkaline phosphatase, real time reverse transcriptase-polymerase chain reaction analysis of vessel endothelial growth factor (VEGF), bone morphogenic protein (BMP)-2, RUNX2 and osteocalcin mRNA expression and von Kossa stain for mineralized nodules.

Results: The shockwave group showed significant increases in MTT, VEGF, alkaline phosphatase, BMP2, RUNX2 and osteocalcin mRNA expression and more mature mineralized nodules compared with the control. Pre-treatment with L-NAME significantly reduced the angiogenic and osteogenic effects of extracorporeal shockwave therapy (ESWT) and the results were comparable with the control. Administration of NOC18 significantly enhanced the angiogenesis and osteogenesis effects compared with the control and the results were comparable with the shockwave group.

Conclusion: ESWT significantly enhanced the angiogenic and osteogenic effects of BMSCs mediated through the NO pathway in hips with osteonecrosis. These innovative findings, at least in part, explain some of the mechanism of shockwaves in osteonecrosis of the hip.

Background: Sprengel deformity is a congenital failure of descent of the scapula. Limited shoulder abduction and cosmetic appearance are the major concerns. Although the Woodward procedure reportedly affords satisfactory correction, the long-term functional outcome postoperatively has not been addressed.

Methods: Eight patients (9 shoulders) who underwent the Woodward procedure for Sprengel deformity were evaluated. The cosmetic appearance and functional results of the shoulders were evaluated using the Cavendish grading system and functional Constant scoring. Grading of the cosmetic appearance, range of motion of the shoulder, and radiographs were obtained for interpretation.

Results: After a mean follow-up of 113 ± 29 months, the cosmetic appearance had improved. The Cavendish cosmetic grade improved significantly (p = 0.000). The superior displacement ratio decreased from 0.5 ± 0.1 to 0.2 ± 0.1 (p = 0.004). The height-to-width ratio of the affected scapula increased from 1.3 ± 0.2 (range 1.1 to 1.7) to 1.6 ± 0.2 (range 1.4 to 2.0) (p = 0.001). The abduction of the shoulder improved from 122 ± 14 (range 100 to 140) degrees to 157 ± 20 (range 125 to 180) degrees (p = 0.008). The average abduction power of the involved shoulders was 21.8 ± 3.2 lbs, which was not significantly different from the uninvolved shoulders 23.1 ± 2.5 lb (p = 0.525). The average Constant score for the operated shoulders was 91.7 ± 4.2 (range 82 to 96) points.

Conclusion: The Woodward procedure offers substantial improvement of shoulder function and cosmetic appearance for patients.

The most prominent sites of Castleman's disease (CD) are the thorax (mediastinum or lung hilum) and abdomen. It rarely occurs in the cervical area and only one case has been reported in the posterior triangle of the neck. We report a new case of cervical posterior triangle CD in a child. A 9-year-old boy presented with an indolent mass in the posterior triangle (level V) on the left side of his neck for more than six months. Complete excision was undertaken and the histopathological diagnosis was CD of the hyaline-vascular type. At the 3-year follow up, there were no signs of recurrence. The etiologies of persistent cervical lymphadenopathy in children vary. Though it is very rare, we should keep in mind that CD is possible. In addition, CD can be either localized (unicentric) or diffuse (multicentric). The treatment and prognosis of these two are quite different. Therefore, for any case of CD, systemic evaluation is recommended for a precise diagnosis and proper management.

Background: Lactoferrin has been shown to exhibit anti-enterovirus 71 (EV71) and antirotavirus properties. This trial was conducted to determine whether a formula containing bovine lactoferrin (bLF) exerts a protective effect against EV71 or rotavirus infection among children from 2 to 6 years old.

Methods: A prospective, randomized, single blind clinical trial of an oral supplement containing bLF (daily dose approximately 70 to 85 mg) was carried out with healthy children in a day care center from March 2002 to June 2003. The incidence of enterovirus or rotavirus infection and the serum level of interferon- gamma (IFN-γ) and interleukin-10 (IL-10) were compared between children receiving and not receiving bLF.

Results: A total of 172 children, 96 in group A, which received bLF, and 76 in group B which did not receive bLF, completed the trial. During the study period, no EV71 was isolated and seroconversion of EV71 antibodies was noted in only one child. Fourteen episodes of presumptive enterovirus infection and 12 episodes of presumptive viral enteritis were detected. No significant differences were observed between groups in the incidence of presumptive enterovirus infection or viral enteritis or the number of laboratory confirmed enterovirus or rotavirus infections. No significant differences were observed in the serum levels of IFN-γ and IL-10 between groups either prior to or following the trial. In both groups, IFN-γ levels increased, but IL-10 was unchanged following the trial.

Conclusion: An oral supplement of bLF at a dose of 70 mg/day did not show any benefits in the prevention of EV71 or rotavirus infection, or any impact on IFN-γ or IL-10 serum levels in healthy children in this trial.

Few previous studies have investigated the pathomechanism and managements of rotator cuff lesions with shoulder stiffness. Based on observations by Codman in 1934, frozen shoulder presumably relates to rotator cuff tendenitis. In the past six decades, tended to discriminate primary frozen shoulder from secondary shoulder stiffness due to shoulder disorders such as rotator cuff lesions or trauma. Intrinsic degeneration and outlet acromial spur impingement are reported as pathogenic causes of rotator cuff lesion. Although patients with rotator cuff lesions with shoulder stiffness or adhesive capsulitis (frozen shoulder) may have similar complaints about pain and motion limitation, the pathological reactions in these disorders remain unclear. In our investigation of clinical vignettes of shoulder stiffness, inflammation-mediated adhesions in the subacromial bursa in rotator cuff lesions, and changes in inflammatory cytokine levels have been linked to myofibroblast recruitment in the subacromial bursa. Our study provides the first indication that increased interleukin -1β expression and myofibroblast recruitment in the subacromial bursa are correlated with rotator cuff lesions with shoulder stiffness. Increased inflammatory cytokine concentrations in the lesions also provide new molecular insight into the pathological role of the subacromial bursa in the development of shoulder stiffness in rotator cuff lesions. Although rotator cuff repair is a shoulder-tightening procedure and is not recommended until resolution of the shoulder stiffness in rotator cuff lesions with stiff shoulder, our clinical evidence-based survey suggests that a combined procedure of manipulation, lysis of adhesions, acromioplasty, and rotator cuff repair is a useful procedure if the symptoms do not improve 3 months of aggressive rehabilitation.

Background: Schizophrenia is accompanied by an activation of the immune/inflammatory system. In the present study, the relationships between serum interleukin (IL)-6, tumor necrosis factor (TNF)-α, and transforming growth factor (TGF)-β1 levels and schizophrenia were explored in a group of Taiwanese inpatients. Furthermore, the serum IL-6, TNF-α, and TGF-β1 levels of patients with schizophrenia were compared before and after 1 month of antipsychotic treatment.

Methods: The serum IL-6, TNF-α, and TGF-β1 levels of 34 acute stage schizophrenic patients and 30 healthy control subjects were collected. These levels were again collected in the 34 patients after 1 month of antipsychotic treatment. An analysis of covariance (ANCOVA) adjusted for gender was performed to examine the differences in cytokine levels between the schizophrenic patients and the control group. Repeated measures ANCOVA adjusted for gender was performed to examine the differences in cytokine levels of the schizophrenic patients before and after 1 month of treatment.

Results: Using ANCOVA adjusted for gender, significantly increased IL-6 levels were found in schizophrenic patients compared with the control group (p = 0.02), but there were no significant differences in TNF-α and TGF-β1 levels (p = 0.06 and 0.91, respectively). After 1 month of medical treatment, there were no significant differences in IL-6 (p = 0.64), TNF-α (p = 0.48), and TGF-β1 (p = 0.23) levels in the schizophrenic patients, although IL-6 appeared to be normalizing.

Conclusion: An increase in the IL-6 level may play a role in the pathophysiology of schizophrenia. A larger sample size and a longer period of follow-up are needed to confirm this finding.

A 78-year-old woman was diagnosed with fibrovascular pigment epithelial detachment (PED) associated with age-related macular degeneration (AMD) affecting both eyes. Due to decreased vision in her left eye (20/2000) and disease progression, the patient received 4 mg of triamcinolone acetonide (TA) by intravitreal injection into her left eye. There were no immediate post-injection complications in the left eye. However, one week later, a retinal pigment epithelial (RPE) tear, temporal-inferior to the fovea in the left eye, was noted and confirmed by fundus photography, fluorescein angiography and optical coherence tomography. In contrast, there no similar RPE tear occurred in her right eye after treated several times by intravitreous bevacizumab injection. Not only anti-vascular endothelium growth factor agents, but also intravitreal TA when used to treat AMD with PED, would seem to induce a RPE tear in the absence of previous or concurrent adjuvant therapy. Further investigations are required to confirm the mechanism by which the RPE tear occurs.

Cancer stemness is a concept used to describe a minor population of cells (cancer stem cells-CSCs) residing in a tumor, which possess self-renewal properties and are resistant to chemo/radiation therapy. Epithelial-mesenchymal transition (EMT), a major mechanism of cancer metastasis, is a process which generates cells with stem-like properties. The relationship between cancer stemness and EMT is well documented but without detailed mechanistic explanation. Bmi1 belongs to the polycomb repressive complex 1 (PRC1) which maintains self-renewal and stemness. Recent results showed that Twist1, an EMT regulator, directly activates Bmi1 and these two molecules function together to mediate cancer stemness and EMT. These results provide a molecular explanation of the relationship between cancer stemness and EMT. Bmi1 is frequently overexpressed in various types of human cancers and can confer drug resistance. Twist1 is also overexpressed in various human cancers with prognostic significance. The functional interdependence between Twist1 and Bmi1 provides a fresh insight into the molecular mechanism of EMT-induced cancer stemness. Further investigation of the mechanisms mediating EMT and cancer stemness will be helpful in the management and treatment of metastatic cancers.

Background: Individuals with non-alcohol fatty liver disease (NAFLD) exhibit impaired liver regeneration in a clinical setting and animal experiments. Adiponectin signaling is recognized as an important pathway of lipid metabolism, energy expenditure, anti-inflammation, and cellular proliferation. We herein investigate hepatic adiponectin signaling in dietary steatotic murine models undergoing hepatectomy, which has never been explored.

Methods: Sprague-Dawley rats fed with a normal diet (normal), high fat diet (HF), and a methionine-choline deficiency diet for 1 week (MCD 1W) and 5 weeks (MCD 5W), were used. The animals underwent 70% hepatectomy and were thereafter sacrificed at indicated time points.

Results: MCD 5W and HF displayed decreased Ki-67 labeling index and restituted liver mass compared to normal. Hepatic adiponectin, as well as TNF-α, of MCD5W and HF were increased compared to normal; whereas adiponectin receptor type 1 (AdipoR1) and adiponectin receptor type 2 (AdpoR2) were reciprocally decreased when compared to normal. PPARα, a downstream molecule of AdipoR2 axis, was decreased in MCD 5W compared to normal. Adenosine monophosphate- activated protein kinase (AMPK), a downstream molecule of AdipoR1 axis, was inactivated soon after hepatectomy in normal; whereas activation of AMPK persisted until day 3 after hepatectomy in MCD 5W and HF.

Conclusions: Reciprocal expression of adiponectin and its receptors in steatotic rats represents a unique form of adiponectin signaling disruption, which might be associated with impaired liver regeneration.

Background: Depression and heavy stress have been reported as two important problems for medical students in previous studies; and stress and depression levels were also related to gender and grades. The aims of this article were to investigate the emotional problems of Taiwanese interns and clerks, and to clarify their relationship to work circumstances, identity of interns and clerks in the hospitals, gender discrepancy and their levels of stress and depression.

Methods: Three medical centers in Taiwan were selected in this study. All interns in the three medical centers and clerks in Chang Gung Memorial Hospital were invited to complete an anonymous self-report questionnaire. The questionnaire included demographic data, levels of various stresses in hospitals recorded with visual analog scales, and a Chinese version of Zun's Selfadministered Depression Scale. One-way analysis of variance was also adopted to compare the distress scores, and the Scheffe test was chosen for the post hoc comparisons.

Results: First, working in different medical centers was not a factor influencing levels of stress and depression of interns. Second, interns had higher stress levels of g"work loading" and "occupational risks", and more depressive symptoms, such as "poor sleep quality", "poor appetite", "libido loss", "body weight loss", and "anhedonia". However, identity did not significantly impact levels of depression. Third, gender discrepancy showed significant influences on some stress sources and depressed symptoms.

Conclusions: When comparing some depressive symptoms and stress sources among medical students, differences of gender and identities were statistically significant. Further longitudinal studies are needed.