Manipulation: investigation of a proposed mechanism

The purpose of this study was to investigate whether spinal manipulation alters the posteroanterior stiffness of the manipulated region. Thirty subjects with no history of thoracic pain or contraindication to manipulation participated. The manipulation studied was a posteroanterior thrust applied to the T_4–5 spinal level. The effect of the manipulation was compared to a control intervention of supine lying. The posteroanterior stiffness of all subjects was measured at the T₄ and T₅ levels initially, and remeasured after both the manipulation and control interventions. Change scores relating to the change in posteroanterior stiffness due to manipulation and due to the control intervention were computed. A t-test comparing the change scores between interventions revealed no significant difference. However, the posteroanterior stiffness at T₅ was found to be significantly greater than at T₄. It was concluded that in the case of asymptomatic subjects these results did not provide support for the hypothesis that posteroanterior stiffness is altered by manipulation.     

Onychomycosis and diabetes

Objective  This study aims to discuss factors specific to diabetics in the diagnosis and treatment of onychomycosis.
Discussion  Onychomycosis has the potential to cause severe complications in diabetics and should be treated promptly. The existence of comorbid conditions and potential for drug–drug interactions complicates the selection of an appropriate treatment regimen. The role of Candida in onychomycosis is controversial but may be of increased significance in the diabetic population due to an underlying vulnerability to this organism.
Conclusions  Terbinafine is an excellent choice in diabetics due to its low risk of drug–drug interaction and proven efficacy against the typical pathogens that cause onychomycosis. Itraconazole, while an effective treatment for onychomycosis, is not a first-choice therapy due to its black-box cardiac warning and numerous drug interactions. Larger studies are needed in diabetics to determine the frequency of candidal nail infections.     

BE.Privé 用艺术阐述质感

经历过几年的市场检验后,高级定制经历了第一次重新洗牌,靠单纯的设计实力、只强调面料质量、顺便做品牌宣传等等单一型的优势竞争已不能满足高级定制从一出生就具有的"挑剔"个性。     

HTK保护液对尸肾移植器官的影响

近期出版的第5期美国移植杂志(American Journal of Transplantation)报道了两项关于比较HTK和UW保护液对尸肾移植物预后的影响的研究结果,来自美国UNOS数据库和内布拉斯加医学中心大学的数据均显示HTK液对尸肾肾移植后移植肾的早期功能恢复不利.     

Recombinant human interleukin-1 receptor antagonist in the treatment of steroid-resistant graft-versus-host disease

Acute graft-versus-host disease (GVHD) that is resistant to therapy is a highly lethal complication of marrow transplantation. Inflammatory cytokines such as interleukin-1 (IL-1) may be critical mediators of this process. If so, specific inhibition of IL-1 activity with recombinant human IL-1 receptor antagonist (IL-1Ra), a naturally occurring competitive inhibitor of IL-1, may ameliorate acute GVHD. We performed an open-label, phase I/II trial to evaluate the safety and efficacy of IL-1Ra in 17 patients with steroid-resistant GVHD. The IL- 1Ra was administered as a 24-hour continuous infusion over 7 days. The dose was escalated in cohorts of patients from 400 to 3,200 mg/d. Acute GVHD was evaluated in each affected organ and as an overall grade. Stage-specific improvement of acute GVHD occurred in the skin (8 of 14, 57%), gut (9 of 11, 82%), and liver (2 of 11, 18%). Overall, acute GVHD improved by at least one grade in 10 of 16 (63%) patients. Response to therapy was associated with a reduction of tumor necrosis factor-alpha (TNF-alpha) mRNA levels in blood mononuclear cells (P = .001). The only toxicity attributable to IL-1Ra was reversible transaminase elevation in two patients. Inhibition of IL-1 activity with IL-1Ra is safe and has demonstrable efficacy in acute GVHD that failed to respond to conventional treatment. These data provide further evidence that IL-1 is a mediator of GVHD.