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Background and Objective: Osteoporosis afflicts a large number of populations in the world and is featured by systemic impairment of bone mass and strength which may further trigger an increase in the risk of fragile fractures. This network meta-analysis (NMA) is designed to distinguish therapies more preferable than others with respect to efficacy and safety. Methods: We searched the medical literature for relevant studies systematically. Both direct and indirect evidence were synthesized to compare the efficacy, described by odds ratios (OR) and 95% credible intervals (CrI). Moreover, the surface under cumulative ranking curve was calculated to rank probabilities with respect to clinical outcomes. The new non-vertebral fractures, hip and wrist fractures, and adverse events were evaluated in this NMA. Results: Patients treated by alendronate, denosumab, teriparatide were associated with a reduced risk of new non-vertebral fractures compared to those treated by placebo. Alendronate, denosumab and zoledronic acid had better efficacy in preventing hip fractures. With respect to wrist fractures prevention, no significant difference was observed. Zoledronic acid exhibited significantly increased risk of adverse events than placebo, alendronate, denosumab, and raloxifene. According to SUCRA, teriparatide ranked highest in new non-vertebral fractures prevention, etidronate and denosumab balanced safety and efficacy well. Conclusion: In summary, teriparatide appeared to be the most efficacious drug for preventing new non-vertebral fractures, while etidronate and denosumab were preferable for balancing safety and efficacy well.

Heterotopic ossification (HO) is a common disturbing complication of intra-articular fractures. Its prevention and treatment are still difficult as its pathogenesis is unclear. It was reported that PDGFRα

AIM:The relationship between cytotoxin-associated protein (CagA)+Helicobacter pylori (H.pylori) infection and gastric cancer in China was reported inconsistently. Using enzyme-linked immunosorbent assay (ELISA) to detect serum anti-CagA antibody and ABC immunohistochemical staining to detect the expression of Bcl-2 and p53 proteins, this study is to explore the relationship between CagA H.pylori infection and expressions of p53 and Bcl-2 proteins in gastric cancer and chronic gastric diseases. METHODS:Seventy-nine patients (50 with gastric cancer, 17 with chronic atrophic gastritis, 5 with gastric ulcer and 7 with chronic superficial gastritis) were diagnosed by endoscopy and biopsied under endoscopy for detection of H.pylori infection, and confirmed by pathological examination. Expression of Bcl-2 and p53 proteins was detected by immunohistochemistry. Rapid urease test and serum H.pylori antibodies with ELISA or Warthin-Starry silver stains were used for H.pylori diagnosis. H.pylori was defined as positive when 2 or 3 of these tests were positive. ELISA was used for the detection of serum anti-CagA antibody. RESULTS:Anti-CagA antibody was present in 43/50 (86 %) gastric cancer and in 13/29 (41 %) chronic gastric disease, CagA+ H.pylori rate in gastric cancer was higher than those in chronic gastric diseases (P 0.05). In CagA+ gastric cancer it was higher than that in CagAone (65 % vs 43 %, P >0.05), and in CagA+ chronic gastric diseases it was higher than that in CagAone (77 % vs 12 %, P

播種性カンジダ症における肺からの血行性伝播の機序を明らかにするため,各種処置を施したマウスに経気道的にCandida albicansを接種して病理組織学的に検討した.ICR及びBALB/cマウスを用い,抗癌剤と副腎皮質ホルモンを腹腔内に4日間投与して,末梢白血球数を4,000/mm3以下とした.C.albicansの生菌2×106個を気管より肺内に接種した.対照動物では全身播種は起こらなかったが,薬物処理マウスでは2日目より血行性播種が観察された.肺では径50μm以下の血管内に侵入した菌体は線維素性血栓で包まれ,血行性播種には至らなかったが,径50μm以上の静脈内に侵入した菌体は全身播種を生じ,マウスの感染死をもたらした.真菌の血管内侵入は肺胞壁と血管壁を直接貫通して行われた.また,I型肺胞上皮が積極的に細胞質突起を出して,真菌を取り囲む像も観察された.上述の薬物処理マウスに生菌を接種した後,ヘパリンを静注すると,真菌の全身播種と感染死の頻度が増加した.予め同種マウスで作られた抗カンジダ抗体を連日静注しておくと,末梢白血球数の上昇が観察され,肺における白血球の浸潤も顕著となり,真菌の全身播種と感染死の頻度が減少した,以上の結果から,C.albicansの肺からの血行性播種には,肺に予め特別な処置をしない場合,ある程度の全身的な生体防御能の低下,特に白血球の減少が必要であり,肺内のやや太い静脈内に真菌が侵入すると血行性播種が起こることが明らかになった.また,血液凝固能やカンジダに対する抗体の存在などが血行性播種に深く関わっていることが示唆された.

Whether bone marrow changes occur and potentially contribute to the hematological abnormalities in liver cirrhosis remain unclear. In this study, we established a rat model of liver cirrhosis induced by carbon tetrachloride. Electron microscopy examination showed focal lesions in bone marrow sinusoidal endothelium and hematopoietic cells in animals with cirrhosis. With the persistence of liver cirrhosis, injuries of bone marrow sinusoidal endothelium progressed from mild mitochondrial changes to nuclear pycnosis and cell disruption, and the trilineage hematopoietic cells showed apoptosis and necrosis. Immunohistochemistry revealed increased expression of E-selectin, P-selectin and vWF in bone marrow sinusoidal endothelium of the cirrhotic rats, which was consistent with the data from semiquantitative reverse transcriptase-polymerase chain reaction analysis. Autopsy specimens from patients with liver cirrhosis (in the absence of other disease) showed the same findings as detected by immunohistochemistry in animal models. The results provide evidence of the association between liver cirrhosis and bone marrow alterations by demonstrating the bone marrow sinusoidal endothelium lesions in both a rat model and patients. It also indicates that activation or injury of bone marrow sinusoidal endothelium mediated by E-selectin, P-selectin, and vWF might have a role in pathogenesis of bone marrow changes during liver cirrhosis. The lesions of bone marrow sinusoidal endothelium might contribute to the hematological abnormalities in the end stage of liver disease.

Evidence for sexual dimorphism in autonomic control of cardiovascular function is both compelling and confounding. Across healthy and disease populations sex-associated differences in neurocirculatory hemodynamics are far too complex to be entirely related to sex hormones. As an initial step toward identifying additional physiological mechanisms, we investigated whether there is a sex bias in the relative expression of low-threshold-myelinated and high-threshold-unmyelinated aortic baroreceptor afferents in rats. These two types of afferent fibers have markedly different reflexogenic effects upon heart rate and blood pressure and thus the potential impact upon baroreflex dynamics could be substantial. Our results, using a combination of a patch-clamp study of fluorescently identified aortic baroreceptor neurons (ABN) and morphometric analysis of aortic baroreceptor nerve fibers, demonstrate that females exhibit a greater percentage of myelinated baroreceptor fibers (24.8% vs. 18.7% of total baroreceptor fiber population, P < 0.01) and express a functional subtype of myelinated ABN rarely found in age-matched males (11% vs. 2.3%, n = 107, P < 0.01). Interestingly, this neuronal phenotype is more prevalent in the general population of female vagal afferent neurons (17.7% vs. 3.8%, n = 169, P < 0.01), and ovariectomy does not alter its expression but does lessen neuronal excitability. These data suggest there are fundamental neuroanatomical and electrophysiological differences between aortic baroreceptor afferents of female and male rats. Possible explanations are presented as to how such a greater prevalence of low-threshold myelinated afferents could be a contributing factor to the altered baroreflex sensitivity and vagal tone of females compared with males.

Background: The relationship between medial meniscus tear and posterior cruciate ligament (PCL) injury has not been exactly explained. We studied to investigate the biomechanical effect of partial and complete PCL transection on different parts of medial meniscus at different flexion angles under static loading conditions. Materials and Methods: Twelve fresh human cadaveric knee specimens were divided into four groups: PCL intact (PCL-I), anterolateral bundle transection (ALB-T), posteromedial bundle transection (PMB-T) and PCL complete transection (PCL-T) group. Strain on the anterior horn, body part and posterior horn of medial meniscus were measured under different axial compressive tibial loads (200-800 N) at 0°, 30°, 60° and 90° knee flexion in each groups respectively. Results: Compared with the PCL-I group, the PCL-T group had a higher strain on whole medial meniscus at 30°, 60° and 90° flexion in all loading conditions and at 0° flexion with 400, 600 and 800 N loads. In ALB-T group, strain on whole meniscus increased at 30°, 60° and 90° flexion under all loading conditions and at 0° flexion with 800 N only. PMB-T exihibited higher strain at 0° flexion with 400 N, 600 N and 800 N, while at 30° and 60° flexion with 800 N and at 90° flexion under all loading conditions. Conclusions: Partial PCL transection triggers strain concentration on medial meniscus and the effect is more pronounced with higher loading conditions at higher flexion angles.