Cytomegalovirus (CMV) is the most important pathogen affecting the outcome of renal transplantation. Reinfection of CMV can occur in CMV-seropositive donors and CMV seropositive recipients (D+/R+) settings because the protection against CMV conferred by preexisting immunity is limited due to its strain-dependent immune responses. To analyze the influence of CMV reinfection in renal transplantation, ELISA using fusion proteins encompassing epitope of glycoprotein H(gH) from both AD169 and Towne strains was employed before transplantation. The CMV-gH seropositive rate increased with increases in age and the rate of samples which contained antibodies against both AD169 and Towne were significantly high in the age of 50 years or over. Antibodies from HLA-DR10 and DR11 were associated with a significantly lower response rate against CMV-gH. In renal transplantation, the high degrees of antigenemia and high incidences of CMV disease are more prevalent in the CMV gH antibody-mismatched group in D+/R+ setting. The nucleotide sequence of the region of the gH epitope in the CMV-DNA extracted from the transplant recipients who showed high degree of antigenemia revealed the CMV reinfection from the donors. As a CMV indirect effect, the incidence of acute rejection in the mismatched gH antibody group was higher than that observed in the matched and D+/R− groups. The adverse events were more likely to occur in cases of D+/R+ renal transplantation with mismatched strain-specific antibodies which would indicates the risk of CMV reinfection after transplantation.
Low doses of methotrexate (MTX) are safe and effective for treating adult and juvenile rheumatoid arthritis. However, because this powerful anti-inflammatory drug might negatively influence the healing of wounds and fractures, MTX administration is often stopped during surgical procedures. The present study assesses the effects of low- and high-dose MTX on early inflammatory processes and bone healing in an experimental model of fracture. Thirty male Sprague-Dawley rats were assigned to low- and high-dose MTX and control groups. A femur was cut using a reciprocating saw and a 2-mm fracture gap was made using a fixator. One or four weeks thereafter, macrophages were immunostained and new bone formation was histomorphometrically measured. Significantly less new bone was formed in the high-dose MTX, than in the control group (p< 0.01), whereas bone formation did not significantly differ between the low-dose MTX and control groups. These results suggested that a low dose of MTX does not affect the early process of endochondral bone formation during fracture healing, whereas a high dose might delay the progress of new periosteal bone formation. Although more macrophages were found in the groups treated with MTX, their impact on surrounding inflammatory processes remains unclear.
Although several studies have reported a lower risk of osteoporotic fracture in hypercholesterolemic patients (WHO IIa) treated with statin, longitudinal studies on the effects of statins on bone are lacking. The aim of the present study was to evaluate bone mineral density (BMD) and bone turnover changes induced by 3-year fluvastatin treatment in postmenopausal women. Twenty-eight consecutive postmenopausal non-diabetic, normotensive hypercholesterolemic women (64.0±3.6 years) were treated for 36 months with 30 mg/day fluvastatin and 28 non-diabetic, normotensive normocholesterolemic age- and body mass index-matched postmenopausal women served as the control subjects. The result revealed a significant increase of the BMD as compared with the level at the base line (p< 0.001) in the fluvastairn-treated group, from 6 months on ward after the start treatment. Significant differences of the BMD were found between the controls and fluvastatin-treated group (p< 0.001) were at 6, 12, 24 and 36 months after the start of the study. In conclusion our results, although obtained small sample of postmenopausal hypercholesterolemic women, suggest a probable favorable effect of fluvastatin on bone formation and BMD.
AIM: Percutaneous Endoscopic Gastrostomy (PEG) placement is a useful but invasive method. Recently, the hemodynamic change of ultrathin transnasal esophagogastroduodenoscopy (transnasal EGD) was reported as less than that of conventional transoral EGD (transoral EGD). This study compared hemodynamic changes between transnasal EGD and transoral EGD in the setting of PEG placement using a modified Introducer method under sedation. METHODS: All 25 patients who were performed PEG in our hospital during the period December 2007 to February 2009 were enrolled in this study. We assigned them randomly to one of two groups, Group A for transoral EGD and Group B transnasal EGD. For both groups, the modified Introducer method was used. Vital signs (systolic blood pressure; SBP, heart rate; HR and rate pressure product; RPP) were monitored before and after scope insertion. RESULTS: We assigned 13 patients to Group A and 12 patients to Group B. The mean age was 69.4 years old in Group A and 69.8 in Group B. After scope insertion, mean changes of vital signs in Group A and B were, respectively, 17.8 mmHg and 17.3 mmHg in SBP, 12.1 bpm and 5.08 bpm in HR, and 25.9 and 17.5 in RPP. CONCLUSION: No significant differences of hemodynamic changes were seen between transnasal EGD and transoral EGD for the PEG placement with modified Introducer method under sedation. Results show that both methods are tolerable and feasible for PEG placement.