Low Load Group Research Articles

Influential factors of prognosis in lamivudine treatment for patients with acute‐on‐chronic hepatitis B liver failure

Chronic hepatitis B virus (HBV) infection is a major global health issue, and the prognosis of patients with HBV-associated acute-on-chronic hepatic failure (ACLF) is extremely poor. In this study, the efficacy of lamivudine was investigated in patients with ACLF. The effects of HBV DNA load and its related factors on the prognosis were also further explored. A matched retrospective cohort study using data on ACLF patients derived from our hospital database was conducted. One hundred and thirty patients receiving lamivudine were selected into the lamivudine treatment group with another 130 without lamivudine treatment studied as control. They were matched for sex, age and imaging finding with the lamivudine treatment group. All the patients were followed up for 3 months and the survival rates were compared. The influential factors on the mortality were studied by the Cox proportional hazards model. The cumulative survival rates of patients in the lamivudine group were higher than those of the control group (chi(2) = 9.50, P = 0.0021). The mortality of patients in the high virus load group (71/95, 74.7%) was higher than that of those in the low virus load group (15/29, 51.7%) (chi(2) = 5.536, P = 0.019). For patients with a Model for End-Stage Liver Disease (MELD) score of 20-30 by week 4, the mortality of those with HBV DNA that was undetectable or declined for more than 2 log(10) (2/12, 16.7%; 18/40, 45.0%) was lower than that of those with a less than 2 log(10) decline (18/23, 78.3%) (chi(2) = 10.106, P = 0.001). In the Cox proportional hazards model, for patients with a MELD score of 20-30, treatment method (P = 0.002), pretreatment HBV DNA load (P = 0.007) and decline of HBV DNA load during therapy (P = 0.003) were independent predictors; for those with a MELD score of above 30, MELD score (P = 0.008) was the only independent predictor. Lamivudine can significantly decrease the 3-month mortality of patients with a MELD score of 20-30, and a low pretreatment viral load and rapid decline of HBV DNA load are good predictors for the outcome of the treatment.

Increased Ig‐null B lymphocytes in the peripheral blood of pediatric solid organ transplant recipients with elevated Epstein‐Barr viral loads

In this study, the characteristics of Ig-null B cells in high viral load carriers were examined by four-color flow cytometry. The frequency of Ig-null B cells in patients with high, low or undetectable virus loads was found that while patients with a high load had more Ig-null cells, these cells were also present in the low and undetectable load groups. As Ig-null cells from patients with no viral load were EBV-negative, EBV infection was not absolutely required for the generation or survival of Ig-null cells. Ig-null cells were CD19(+), sIg(-), CD5(-), CD10(-), CD27(-), CD23(-), CD38(-), and CD69(-) with variable surface expression of CD20 and CD40. Ig-null cells did not have a proliferating cell phenotype (Ki67(-)) and a high proportion were HLA class I(-) and class II(-). Virus copy number in CD19(+) Ig-null cell populations may be much higher than in CD19(+) Ig(+) cell populations. EBV infected Ig-null cells were common in blood specimens from pediatric solid organ transplant recipients and infected Ig-null cells may pose potential problems for immunotherapies that target infected B cells directly.

Displaced Olecranon Fractures in Children

Wire and suture methods have been used to stabilize pediatric olecranon fractures. This study (1) compared differences in simulated intraoperative compression during fracture reduction, (2) evaluated articular surface compression during cyclic loading of the tension band, and (3) compared fracture stabilization after cyclic physiologic loading at low/high levels. Identical olecranon fractures were created in 10 synthetic ulnae and randomized to suture or wire fixation. Compression after fixation and compression during cyclic loading between 10 and 50 N was measured with a load cell at the articular surface and compared with a 1-way analysis of variance (p < 0.05). Twenty-four fractured synthetic ulna were randomly assigned to wire or suture tension band constructs and low- or high-loading groups. The low-load group (12 ulnae) cycled loading from 3 to 10 N for 100 cycles followed by a failure test. The high-load group (12 ulnae) experienced 10 to 100 N before failure testing. Fracture separation (mm) and failure load (N) were compared using a 2-way analysis of variance (p < 0.05). Ten synthetic ulnae were randomized to wire/suture groups and cyclically loaded between 10 to 50 N while measuring loads across the fracture using a load cell. Correlation data were statistically compared with a Fisher transformation and z test (p < 0.05). Residual compression was statistically greater for wire compared with suture. There was no difference in fracture displacement between groups during low loads. Suture had significantly greater displacement compared with wire at high loads. Failure loads were significantly greater for wire at both load settings. Wires transmitted forces across the joint surface more readily than sutures. Suture tension bands had lower ultimate failure loads and less compression at the fracture site. However, if low loads are expected or if the fracture is reduced easily, the suture tension band may be an appropriate alternative to wire fixation. Perhaps, in small children or when using casts in bigger children, a bioabsorbable suture may be used for fracture stabilization avoiding the need for extensive surgery to remove the fixation material.

Electromyographical study on muscle fatigue in repetitive forearm tasks

The purpose of this study was to examine whether repetitive muscle tasks in low weight load might influence the fatigue of forearm muscles, and to identify ergonomic risk factors of forearm muscle fatigue in these tasks. Sixteen healthy male volunteers performed eight wrist extensions in different frequency, weight and angle loads while being instructed to keep a dominant upper limb posture as constant as possible. Surface electromyograph (sEMG) was recorded from right extensors digitorium (ED), flexor carpi radialis (FCR), flexor carpi ulnaris (FCU) and extensor carpi ulnaris (ECU) during the task performance. Our results showed that mean power frequency (MPF) and median frequency (MF) values of ED, FCR and FCU were significantly lower (P<0.05) at high frequency load level than at low load level. However, MPF and MF values of ED were significantly lower (P<0.01) in higher load groups of frequency, angle and weight than in lower load groups. These results indicated that the fatigue of muscles varied in the same task, and the number-one risk factor of ECU, ED and FCR was angle load.

Lumbar Intervertebral Disk Degeneration in Elite Competitive Swimmers

Background The majority of orthopaedic problems experienced by competitive swimmers are related to pain in the shoulder, low back, and knee. Three of 39 national swim team members were hampered in their performance due to lumbar disk herniation at an international competition in 2001. There has been no previous research into lumbar disk degeneration in elite competitive swimmers. Hypothesis Excessive competitive swimming activities accelerate lumbar disk degeneration. Study Design Case control study; Level of evidence, 3. Methods Fifty-six elite swimmers (high-load group, 35 men and 21 women; mean age, 19.6 years) and a control group of 38 university recreational level swimmers (low-load group, 24 men and 14 women; mean age, 21.1 years) were evaluated for lumbar disk degeneration using magnetic resonance imaging. We compared the prevalence of disk degeneration and the disk level between the 2 groups and further investigated the relationship among their symptoms, swimming styles, and disk degeneration. Results Thirty-eight (68%) elite swimmers and 11 (29%) controls had degenerated disks at various disk levels, and the prevalence was significantly greater in the elite swimmers (P = .0002). Comparison between the 2 groups of the prevalence of disk degeneration at each level revealed that the disk level of L5-S1 was significantly more frequently degenerated in the high-load group (P = .026). There was no significant relationship observed among the variables of low back pain symptoms, swimming strokes, and disk degeneration. Conclusion Excessive competitive swimming activities might exaggerate lumbar intervertebral disk degeneration, especially in the L5-S1 intervertebral segment. Keywords lumbar intervertebral disk; disk degeneration; swimming; sports

Urinary free cortisol and cortisone excretion in healthy individuals: Influence of water loading

The influence of water loading on urinary excretion of free cortisol and cortisone was investigated in healthy men. The results were as follows: water loading tests (intake of 0.25–1.5 L) in a single individual showed that a water load of 1.5 L reliably increased the excretion of urine, free cortisol and cortisone ( p < 0.01). Regression analyses gave significant correlations of urine volume with free cortisol and free cortisone, and of free cortisol and free cortisone. Corresponding results were obtained when water loading tests were performed in males who ingested 1.5 L of water ( n = 8): the excretion of urine, free cortisol and free cortisone were significantly augmented; correlated was urine volume with free cortisol and free cortisone, and free cortisol with free cortisone. In a third set of tests, volunteers collected one 5 h urine (10:00–15:00 h) after the intake of 3× 0.1 or 0.5 L at 11:00, 12:00 and 14:00 h. Excretion of urine, free cortisol and free cortisone in males of the low water loading group (3× 0.1 L) was 0.59 mL/min, and 8.2 or 15.0 μg/5 h; corresponding values in individuals ingesting 3× 0.5 L of water were 1.5 mL/min ( p < 0.01), 12.3 μg/5 h ( p > 0.05) and 26.3 μg/5 h ( p < 0.02). In summary, urinary free cortisol and cortisone excretion in healthy men depends on urine volume, especially during water diuresis. Thus, interpretation of free cortisol and especially of free cortisone excretion is only possible if subjects strictly control their fluid intake and if urine volume is considered an important pre-analytical parameter—otherwise, interpretation of urinary free cortisol results is difficult and of urinary free cortisone data remains tenuous at best.

The effect of minimum load on the fluid uptake and wear of highly crosslinked UHMWPE total hip acetabular components

Thirteen total hip replacement acetabular components of the same design (32mm diameter, cup liners made of highly crosslinked ultra-high molecular weight polyethylene (UHMWPE)) were tested in an AMTI hip simulator (six in wear stations and seven in load-soak stations). Two additional liners were immersed in undiluted bovine calf serum but not loaded. The test conditions were otherwise similar for all wear and load-soak samples, with the following exceptions: (a) no motion was applied onto load-soak liners; (b) the minimum load during the swing phase was set at 40N for three of the wear liners and four of the load-soak liners (group A: low minimum load), and 230N for the remaining three wear liners and three load-soak liners (group B: high minimum load). It was found that: (a) load-soak liners gained about 10 times more weight than no-load soak liners; (b) load-soak liners in the low minimum load group gained twice as much weight as those in the high minimum load group, and (c) the observed wear rates were low for both groups; surprisingly, however, the wear rates of the low minimum load liners were also higher than those of the high minimum load liners. This study showed for the first time that the fluid uptake and wear rates of highly crosslinked UHMWPE are sensitive to small differences in the loading pattern.

Response of Preterm Infants to Aluminum in Parenteral Nutrition

Twenty-five preterm infants with birth weights (BW) 540 to 2280 g (20 with birth weight less than 1500 g) and gestational ages 24 to 37 weeks, were studied to determine the response to 2 levels of aluminum (Al) loading from currently unavoidable contamination of various components of parenteral nutrition (PN) solution. High Al loading group (H) received solutions with measured Al content of 306 +/- 16 micrograms/liter and low A1 loading group (L) received solutions with 144 +/- 16 micrograms A1/liter. Urine Al:Creatinine (Al:Cr) ratios (micrograms:mg) became elevated and significantly higher in H (1.6 +/- 0.38 vs 0.5 +/- 0.1, p less than 0.05) at the third sampling point (mean 19 days). Serum Al concentrations were highest at onset in both groups and stabilized with study but remained consistently higher than the normal median of 18 micrograms/liter. Calculated urine Al excretion were consistently low and were 34 +/- 6% vs 28 +/- 5% in the H and L groups, respectively. One infant in the L group who died 39 days after termination of above study showed the presence of A1 in bone trabeculae and the presence of excessive unmineralized osteoid along the trabeculae. We conclude that small preterm infants are able to increase urine Al excretion with increased Al load. However urine Al excretion is incomplete with bone deposition of Al and persistently elevated serum Al concentrations.

Muscle strength and muscle endurance of middle-aged women and men associated to type, duration and intensity of muscular load at work.

Muscle strength and muscle endurance in groups with different occupational muscular load was studied among 60 women and 69 men. The mean age of the subjects was 52.0 +/- 3.4 years. Isometric grip and trunk strength were measured on dynamometers, and dynamic muscle endurance by sit-ups. A job analysis was done with the AET method including the assessment of intensity, duration and type of muscular work of each subject. According to the job analysis, the subjects were classified into groups with low or high muscular load at work. The maximal isometric hand grip strength of women with a load classified as long duration of static or dynamic load on the hands at work was 86 and 88%, respectively of the strength of those with a load of short duration. The women with high intensity in static work had a grip strength of 86% of those with low intensity. These differences in strength among women between the high and low load groups were statistically significant (P less than 0.05). No other statistically significant differences in muscle strength or muscle endurance between the high and low work load groups were found, although the high work load group had systematically the lowest muscle strength and muscle endurance in almost all comparisons. Muscle strength and muscle endurance was, however, not a discriminating factor between the group classifications of static and dynamic work. The results indicated that the muscle strength and muscle endurance of middle-aged employees was systematically lower among those with high muscular load compared to those with low load at work.

Autologous bone marrow transplantation in the treatment of poor prognosis non-Hodgkin's lymphomas

Twelve patients with non-Hodgkin's lymphomas of poor prognosis were treated by TCC high-dose chemotherapy (cyclophosphamide 45 mg/kg/day × 4, cytosine arabinoside 200 mg/m 2 i.v. q 12 hr × 7,6-thioguanin 100 mg/m 2 p.o. × 7 and CCNU 200 or 250 mg/m 2 p.o., single dose) followed by autologous bone marrow transplantation (ABMI) (infused dose: 853–20000 CFU-c/kg). Patients were divided into 2 groups: those in primary therapy with high tumor load (group 1; 3 initial diagnoses, 3 relapses) and those in consolidation therapy for a low tumor load (group 2; 5 complete and 1 partial remissions). Results show that: (1) the aplasia following autologous bone marrow transplantation was short. Leukocyte (>10 9/ l) and platelet (>50 × 10 9/ l) recoveries were observed on day 12 (range, 9–19) and day 14 (range, 8–27). (2) In group 1 there were 3 complete remissions (8, 21, 45+ months and 3 failures, including 1 death to toxicity of TACC. The 3 remissions occurred in patients in primary therapy and overall survival of these patients from the time of initial diagnosis was 48+, 48+ and 60+ months. In group 2 there were 5 persisting complete remissions (12+ to 40+ months) and 1 failure. Overall survival of these patients was 23+, 24+, 27+, 42+ and 70+ months. In both groups failures were associated with contamination of the frozen marrow by tumor. The toxicity of the association TACC + ABMT was acceptable and dominated by the risk of pericardial effusion and infection. The latter was absent in group 2 and occurred in 5 6 cases in group 1. These preliminary results indicate that autologous bone marrow transplantation has a possible role in the aggressive treatment of non-Hodgkin's lymphomas of high-grade malignancy and that its use should preferentially be in the consolidation mode.

Improved Survival of Increased-Risk Myeloma Patients on Combined Triple-Alkylating-Agent Therapy: A Study of the CALGB

AbstractTwo hundred fifty-two previously untreated evaluable patients with multiple myeloma were entered into a study testing a regimen of three intravenous alkylating agents, melphalan, cyclophosphamide, and carmustine (BCNU), given in combination (BCMP) against a regimen employing oral melphalan (MP). Both regimens included a tapering course of prednisone. Objective responses based on the Myeloma Task Force criteria were significantly more frequent in the group receiving BCMP. Survival for the entire group of BCMP-treated patients was not significantly better than that for MP-treated patients (p = 0.62). However, when the survival of the poor-risk (high tumor cell load) group of patients treated with BCMP was compared with the survival of the poor-risk (high tumor cell load) group of patients treated with MP, an improvement in survival attributable to BCMP therapy was seen (p = 0.049 and 0.02, respectively). In the good-risk (low and intermediate tumor cell load) group, BCMP treatment resulted in a trend toward poorer survival, but this did not achieve statistical significance (p =0.080 and 0.23, respectively). These results indicate that optimal therapy in myeloma may be dependent on the extent of disease at the time of first treatment. Additional studies to explore the effects of treatment intensity and duration are needed in order to design improved myeloma treatment based on the patient's extent of disease.

Improved survival of increased-risk myeloma patients on combined triple- alkylating-agent therapy: a study of the CALGB

Two hundred fifty-two previously untreated evaluable patients with multiple myeloma were entered into a study testing a regimen of three intravenous alkylating agents, melphalan, cyclophosphamide, and carmustine (BCNU), given in combination (BCMP) against a regimen employing oral melphalan (MP). Both regimens included a tapering course of prednisone. Objective responses based on the Myeloma Task Force criteria were significantly more frequent in the group receiving BCMP. Survival for the entire group of BCMP-treated patients was not significantly better than that for MP-treated patients (p = 0.62). However, when the survival of the poor-risk (high tumor cell load) group of patients treated with BCMP was compared with the survival of the poor-risk (high tumor cell load) group of patients treated with MP, an improvement in survival attributable to BCMP therapy was seen (p = 0.049 and 0.02, respectively). In the good-risk (low and intermediate tumor cell load) group, BCMP treatment resulted in a trend toward poorer survival, but this did not achieve statistical significance (p = 0.080 and 0.23, respectively). These results indicate that optimal therapy in myeloma may be dependent on the extent of disease at the time of first treatment. Additional studies to explore the effects of treatment intensity and duration are needed in order to design improved myeloma treatment based on the patient's extent of disease.