Spine fractures account for a large portion of musculoskeletal injuries worldwide. A classification of spine fractures is necessary in order to develop a common language for treatment indications and outcomes. Several...Spine fractures account for a large portion of musculoskeletal injuries worldwide. A classification of spine fractures is necessary in order to develop a common language for treatment indications and outcomes. Several classification systems have been developed based on injury anatomy or mechanisms of action, but they have demonstrated poor reliability, have yielded little prognostic information, and have not been widely used. For this reason, the Arbeitsgemeinschaftfür Osteosynthesefragen(AO) committee has classified thorocolumbar spine injuries based on the pathomorphological criteria into3 types(A: Compression; B: Distraction; C: Axial torque and rotational deformity). Each of these types is further divided into 3 groups and 3 subgroups reflecting progressive scale of morphological damage and the degree of instability. Because of its highly detailed sub classifications, the AO system has shown limited interobserver variability. It is similar to its predecessors in that it does not incorporate the patient's neurologic status.The need for a reliable, reproducible, clinically relevant, prognostic classification system with an optimal balance of ease of use and detail of injury description contributed to the development of a new classification system, the thoracolumbar injury classification and severity score(TLICS). The TLICS defines injury based on three clinical characteristics: injury morphology, integrity of the posterior ligamentous complex, and neurologic status of the patient. The severity score offers prognostic information and is helpful in decision making about surgical vs nonsurgical management.展开更多
Diabetic cardiomyopathy is a disease process in which diabetes produces a direct and continuous myocardial insult even in the absence of ischemic, hypertensive or valvular disease. The β-blocking agents bisoprolol, c...Diabetic cardiomyopathy is a disease process in which diabetes produces a direct and continuous myocardial insult even in the absence of ischemic, hypertensive or valvular disease. The β-blocking agents bisoprolol, carvedilol and metoprolol have been shown in large-scale randomized controlled trials to reduce heart failure mortality. In this review, we summarize the results of our studies investigating the effects of β-blocking agents on cardiac function and metabolism in diabetic heart failure, and the complex inter-related mechanisms involved. Metoprolol inhibits fatty acid oxidation at the mitochondrial level but does not prevent lipotoxicity; its benefi cial effects are more likely to be due to prosurvival effects of chronic treatment. These studies have expanded our understanding of the range of effects produced by β-adrenergic blockade and showhow interconnected the signaling pathways of function and metabolism are in the heart. Although our initial hypothesis that inhibition of fatty acid oxidation would be a key mechanism of action was disproved, unexpected results led us to some intriguing regulatory mechanisms of cardiac metabolism. The fi rst was upstream stimulatory factor-2-mediated repression of transcriptional master regulator PGC-1α, most likely occurring as a consequence of the improved function; it is unclear whether this effect is unique to β-blockers, although repression of carnitine palmitoyltransferase (CPT)-1 has not been reported with other drugs which improve function. The second was the identif ication of a range of covalent modifications which can regulate CPT-1 directly, mediated by a signalome at the level of the mitochondria. We also identif ied an important interaction between β-adrenergic signaling and caveolins, which may be a key mechanism of action of β-adrenergic blockade. Our experience with this labyrinthine signaling web illustrates that initial hypotheses and anticipat-ed directions do not have to be right in order to open up meaningful directions or reveal new information.展开更多
Purpose:Hip fractures in elderly have a high mortality.However,there is limited literature on the excess mortality seen in hip fractures compared to the normal population.The purpose of this study was to compare the m...Purpose:Hip fractures in elderly have a high mortality.However,there is limited literature on the excess mortality seen in hip fractures compared to the normal population.The purpose of this study was to compare the mortality of hip fractures with that of age and gender matched Indian population.Methods:There are 283 patients with hip fractures aged above 50 years admitted at single centre prospectively enrolled in this study.Patients were followed up for 1 year and the follow-up record was available for 279 patients.Mortality was assessed during the follow-up from chart review and/or by telephonic interview.One-year mortality of Indian population was obtained from public databases.Standardized mortality ratio(SMR)(observed mortality divided by expected mortality)was calculated.Kaplan-Meir analysis was used.Results:The overall 1-year mortality was 19.0%(53/279).Mortality increased with age(p<0.001)and the highest mortality was seen in those above 80 years(aged 50-59 years:5.0%,aged 60-69 years:19.7%,aged 70-79 years:15.8%,and aged over 80 years:33.3%).Expected mortality of Indian population of similar age and gender profile was 3.7%,giving a SMR of 5.5.SMR for different age quintiles were:3.9(aged 50-59 years),6.6(aged 60-69 years),2.2(aged 70-79 years);and 2.0(aged over 80 years).SMR in males and females were 5.7 and 5.3,respectively.Conclusions:Indian patients sustaining hip fractures were about 5 times more likely to die than the general population.Although mortality rates increased with age,the highest excess mortality was seen in relatively younger patients.Hip fracture mortality was even higher than that of myocardial infarction,breast cancer,and cervical cancer.展开更多
A 19-year-old man had an accidental fall from the 2nd floor and sustained multiple injuries.On radiological evaluation,the patient had symmetrical quadruple limb involvement with bilateral humerus shaft,bilateral olec...A 19-year-old man had an accidental fall from the 2nd floor and sustained multiple injuries.On radiological evaluation,the patient had symmetrical quadruple limb involvement with bilateral humerus shaft,bilateral olecranon,bilateral femur shaft,and bilateral patella fractures.The patient was actively managed using damage control orthopaedics,and a sequence of skeletal fixation was planned based on the hemodynamic stability and periodical serum lactate assessment.Symmetrical quadruple limb fractures are very rare,which could be associated with higher mortality.A meticulous clinical evaluation,periodical blood parameter assessment and strict adherence to the principles of damage control orthopaedics can be conducive to prevent life-endangering complications.展开更多
The present research aimed to improve the dissolution rate and bioavailability of curcumin using the potential of liquisolid technology. Twelve drug-loaded liquisolid systems(LS-1 to LS-12) were prepared using differe...The present research aimed to improve the dissolution rate and bioavailability of curcumin using the potential of liquisolid technology. Twelve drug-loaded liquisolid systems(LS-1 to LS-12) were prepared using different vehicles(PEG 200, PEG 400 and Tween 80) and curcumin concentrations in vehicle(40%, 50%, 60% and 70%, w/w). The carrier [microcrystalline cellulose(MCC) PH102] to coat(Aerosils) ratio was 20 in all formulations. The systems were screened for pre-compression properties before being compressed to liquisolid tablets(LT-1 to LT-12). Post compression tests and in vitro dissolution of LTs were conducted and the results compared with those obtained for a directly compressed tablet(DCT) made of curcumin, MCC PH102 and Aerosils. LTs exhibited higher cumulative drug release(CDR) than the DCT and the optimum formulation, LT-9(made using Tween 80), was studied by powder XRD, DSC, SEM and FTIR. Ex-vivo permeation of curcumin from LT-9 through goat gastrointestinal mucosa was significantly(Po0.05) enhanced and its oral bioavailability was increased18.6-fold in New Zealand rabbits. In vitro cytotoxicity(IC50) of LT-9 towards NCL 87 cancer cells was40.2 mmol/L substantiating its anticancer efficacy. Accelerated stability studies revealed insignificant effects of temperature and humidity on LT-9. In summary, solubility enhancement of curcumin in LTs produced significant improvements in its permeation and bioavailability.展开更多
Background:Regional anaesthesia has been proposed to reduce intraoperative blood loss,duration of hospital stay and in-hospital complications with improved postoperative pain control.General anaesthesia is advantageou...Background:Regional anaesthesia has been proposed to reduce intraoperative blood loss,duration of hospital stay and in-hospital complications with improved postoperative pain control.General anaesthesia is advantageous for prolonged surgeries.We hypothesized that combined regional and general anaesthesia would offer advantages of both in pelvi-acetabular fracture surgeries.Methods:We identified 71 patients who underwent open reduction and internal fixation of pelvi-acetabular fractures from May 2012 to 2013 in our trauma centre.We excluded patients with incomplete records(n=4)and other injuries operated along(n=8).Hence,59 patients were divided into three groups:G group(general anaesthesia),R group(regional anaesthesia)and GR group(combined regional and general anaesthesia).Main outcome measurements studied were intraoperative blood loss,duration of hospital stay,duration of surgery and intraoperative and postoperative complications.Results:No differences were obtained in between the groups in terms of age,gender,Injury Severity Score,number of comorbidities,or duration from injury to surgery.No significant differences were found between the three groups for intraoperative blood loss,days of hospital stay and duration of surgery.Intraoperative and postoperative complications were also comparable between the groups(p>0.05).Conclusions:There is no specific significant advantage of the technique of anaesthesia on the observed perioperative complications in pelvi-acetabular fracture surgeries.展开更多
文摘Spine fractures account for a large portion of musculoskeletal injuries worldwide. A classification of spine fractures is necessary in order to develop a common language for treatment indications and outcomes. Several classification systems have been developed based on injury anatomy or mechanisms of action, but they have demonstrated poor reliability, have yielded little prognostic information, and have not been widely used. For this reason, the Arbeitsgemeinschaftfür Osteosynthesefragen(AO) committee has classified thorocolumbar spine injuries based on the pathomorphological criteria into3 types(A: Compression; B: Distraction; C: Axial torque and rotational deformity). Each of these types is further divided into 3 groups and 3 subgroups reflecting progressive scale of morphological damage and the degree of instability. Because of its highly detailed sub classifications, the AO system has shown limited interobserver variability. It is similar to its predecessors in that it does not incorporate the patient's neurologic status.The need for a reliable, reproducible, clinically relevant, prognostic classification system with an optimal balance of ease of use and detail of injury description contributed to the development of a new classification system, the thoracolumbar injury classification and severity score(TLICS). The TLICS defines injury based on three clinical characteristics: injury morphology, integrity of the posterior ligamentous complex, and neurologic status of the patient. The severity score offers prognostic information and is helpful in decision making about surgical vs nonsurgical management.
基金Supported by The Canadian Institutes of Health Research and the Heart and Stroke Foundation of Canada
文摘Diabetic cardiomyopathy is a disease process in which diabetes produces a direct and continuous myocardial insult even in the absence of ischemic, hypertensive or valvular disease. The β-blocking agents bisoprolol, carvedilol and metoprolol have been shown in large-scale randomized controlled trials to reduce heart failure mortality. In this review, we summarize the results of our studies investigating the effects of β-blocking agents on cardiac function and metabolism in diabetic heart failure, and the complex inter-related mechanisms involved. Metoprolol inhibits fatty acid oxidation at the mitochondrial level but does not prevent lipotoxicity; its benefi cial effects are more likely to be due to prosurvival effects of chronic treatment. These studies have expanded our understanding of the range of effects produced by β-adrenergic blockade and showhow interconnected the signaling pathways of function and metabolism are in the heart. Although our initial hypothesis that inhibition of fatty acid oxidation would be a key mechanism of action was disproved, unexpected results led us to some intriguing regulatory mechanisms of cardiac metabolism. The fi rst was upstream stimulatory factor-2-mediated repression of transcriptional master regulator PGC-1α, most likely occurring as a consequence of the improved function; it is unclear whether this effect is unique to β-blockers, although repression of carnitine palmitoyltransferase (CPT)-1 has not been reported with other drugs which improve function. The second was the identif ication of a range of covalent modifications which can regulate CPT-1 directly, mediated by a signalome at the level of the mitochondria. We also identif ied an important interaction between β-adrenergic signaling and caveolins, which may be a key mechanism of action of β-adrenergic blockade. Our experience with this labyrinthine signaling web illustrates that initial hypotheses and anticipat-ed directions do not have to be right in order to open up meaningful directions or reveal new information.
文摘Purpose:Hip fractures in elderly have a high mortality.However,there is limited literature on the excess mortality seen in hip fractures compared to the normal population.The purpose of this study was to compare the mortality of hip fractures with that of age and gender matched Indian population.Methods:There are 283 patients with hip fractures aged above 50 years admitted at single centre prospectively enrolled in this study.Patients were followed up for 1 year and the follow-up record was available for 279 patients.Mortality was assessed during the follow-up from chart review and/or by telephonic interview.One-year mortality of Indian population was obtained from public databases.Standardized mortality ratio(SMR)(observed mortality divided by expected mortality)was calculated.Kaplan-Meir analysis was used.Results:The overall 1-year mortality was 19.0%(53/279).Mortality increased with age(p<0.001)and the highest mortality was seen in those above 80 years(aged 50-59 years:5.0%,aged 60-69 years:19.7%,aged 70-79 years:15.8%,and aged over 80 years:33.3%).Expected mortality of Indian population of similar age and gender profile was 3.7%,giving a SMR of 5.5.SMR for different age quintiles were:3.9(aged 50-59 years),6.6(aged 60-69 years),2.2(aged 70-79 years);and 2.0(aged over 80 years).SMR in males and females were 5.7 and 5.3,respectively.Conclusions:Indian patients sustaining hip fractures were about 5 times more likely to die than the general population.Although mortality rates increased with age,the highest excess mortality was seen in relatively younger patients.Hip fracture mortality was even higher than that of myocardial infarction,breast cancer,and cervical cancer.
文摘A 19-year-old man had an accidental fall from the 2nd floor and sustained multiple injuries.On radiological evaluation,the patient had symmetrical quadruple limb involvement with bilateral humerus shaft,bilateral olecranon,bilateral femur shaft,and bilateral patella fractures.The patient was actively managed using damage control orthopaedics,and a sequence of skeletal fixation was planned based on the hemodynamic stability and periodical serum lactate assessment.Symmetrical quadruple limb fractures are very rare,which could be associated with higher mortality.A meticulous clinical evaluation,periodical blood parameter assessment and strict adherence to the principles of damage control orthopaedics can be conducive to prevent life-endangering complications.
文摘The present research aimed to improve the dissolution rate and bioavailability of curcumin using the potential of liquisolid technology. Twelve drug-loaded liquisolid systems(LS-1 to LS-12) were prepared using different vehicles(PEG 200, PEG 400 and Tween 80) and curcumin concentrations in vehicle(40%, 50%, 60% and 70%, w/w). The carrier [microcrystalline cellulose(MCC) PH102] to coat(Aerosils) ratio was 20 in all formulations. The systems were screened for pre-compression properties before being compressed to liquisolid tablets(LT-1 to LT-12). Post compression tests and in vitro dissolution of LTs were conducted and the results compared with those obtained for a directly compressed tablet(DCT) made of curcumin, MCC PH102 and Aerosils. LTs exhibited higher cumulative drug release(CDR) than the DCT and the optimum formulation, LT-9(made using Tween 80), was studied by powder XRD, DSC, SEM and FTIR. Ex-vivo permeation of curcumin from LT-9 through goat gastrointestinal mucosa was significantly(Po0.05) enhanced and its oral bioavailability was increased18.6-fold in New Zealand rabbits. In vitro cytotoxicity(IC50) of LT-9 towards NCL 87 cancer cells was40.2 mmol/L substantiating its anticancer efficacy. Accelerated stability studies revealed insignificant effects of temperature and humidity on LT-9. In summary, solubility enhancement of curcumin in LTs produced significant improvements in its permeation and bioavailability.
文摘Background:Regional anaesthesia has been proposed to reduce intraoperative blood loss,duration of hospital stay and in-hospital complications with improved postoperative pain control.General anaesthesia is advantageous for prolonged surgeries.We hypothesized that combined regional and general anaesthesia would offer advantages of both in pelvi-acetabular fracture surgeries.Methods:We identified 71 patients who underwent open reduction and internal fixation of pelvi-acetabular fractures from May 2012 to 2013 in our trauma centre.We excluded patients with incomplete records(n=4)and other injuries operated along(n=8).Hence,59 patients were divided into three groups:G group(general anaesthesia),R group(regional anaesthesia)and GR group(combined regional and general anaesthesia).Main outcome measurements studied were intraoperative blood loss,duration of hospital stay,duration of surgery and intraoperative and postoperative complications.Results:No differences were obtained in between the groups in terms of age,gender,Injury Severity Score,number of comorbidities,or duration from injury to surgery.No significant differences were found between the three groups for intraoperative blood loss,days of hospital stay and duration of surgery.Intraoperative and postoperative complications were also comparable between the groups(p>0.05).Conclusions:There is no specific significant advantage of the technique of anaesthesia on the observed perioperative complications in pelvi-acetabular fracture surgeries.
