Survey of awareness and attitudes to the management of fragility fractures among the membership of the Asia Pacific Orthopaedic Association

A survey of awareness and attitudes to the management of fragility fractures among the membership of the Asia Pacific Orthopaedic Association conducted in 2022 found considerable variation in care across the region. A Call to Action is proposed to improve acute care, rehabilitation and secondary fracture prevention across Asia Pacific.

PURPOSE

Fragility fractures impose a substantial burden on older people and their families, healthcare systems and national economies. The current incidence of hip and other fragility fractures across the Asia Pacific region is enormous and set to escalate rapidly in the coming decades. This publication describes findings of a survey of awareness and attitudes to the management of fragility fractures among the membership of the Asia Pacific Orthopaedic Association (APOA) conducted in 2022.

METHODS

The survey was developed as a collaboration between the Asia Pacific Osteoporosis and Fragility Fracture Society and the Asia Pacific Fragility Fracture Alliance, and included questions relating to aspects of care upon presentation, during surgery and mobilisation, secondary fracture prevention, and access to specific services.

RESULTS

In total, 521 APOA members completed the survey and marked variation in delivery of care was evident. Notable findings included: Fifty-nine percent of respondents indicated that analgesia was routinely initiated in transit (by paramedics) or within 30 minutes of arrival in the Emergency Department. One-quarter of respondents stated that more than 80% of their patients underwent surgery within 48 hours of admission. One-third of respondents considered non-hip, non-vertebral fractures to merit assessment of future fracture risk. One-third of respondents reported the presence of an Orthogeriatric Service in their hospital, and less than a quarter reported the presence of a Fracture Liaison Service.

CONCLUSION

A Call to Action for all National Orthopaedic Associations affiliated with APOA is proposed to improve the care of fragility fracture patients across the region.

Scoliocorrector Fatma-UI for correction of adolescent idiopathic scoliosis: Development, effectivity, safety and functional outcome

BACKGROUND

Adolescent idiopathic scoliosis remains a major problem due to its high incidence, high risk, and high cost. One of the aims of the management in scoliosis is to correct the deformity. Many techniques are available to correct scoliosis deformity; however, they are all far from ideal to achieve three-dimensional correction in scoliosis.

AIM

To develop a set of tools named Scoliocorrector Fatma-UI (SCFUI) to aid three-dimensional correction and to evaluate the efficacy, safety, and functional outcome.

METHODS

This study consists of two stages. In the first stage, we developed the SCFUI and tested it in finite element and biomechanical tests. The second stage was a single-blinded randomized clinical trial to evaluate the SCFUI compared to direct vertebral rotation (DVR). Forty-four subjects with adolescent idiopathic scoliosis were randomly allocated into the DVR group (n = 23) and SCFUI group (n = 21). Radiological, neurological, and functional outcome was compared between the groups.

RESULTS

Finite element revealed the maximum stress of the SCFUI components to be between 31.2 - 252 MPa. Biomechanical analysis revealed the modulus elasticity of SCFUI was 9561324 ± 633277 MPa. Both groups showed improvement in Cobb angle and sagittal profile, however the rotation angle was lower in the SCFUI group (11.59 ± 7.46 vs 18.23 ± 6.39, P = 0.001). Neurological and functional outcome were comparable in both groups.

CONCLUSION

We concluded that SCFUI developed in this study resulted in similar coronal and sagittal but better rotational correction compared to DVR. The safety and functional outcomes were also similar to DVR.

Randomized controlled trial of vitamin d supplementation on toll-like receptor-2 (tlr-2) and toll-like receptor-4 (tlr-4) in tuberculosis spondylitis patients

BACKGROUND

Tuberculosis spondylitis accounts for approximately 50% of all cases of skeletal tuberculosis. Vitamin D plays a role in the immune system. Vitamin D helps in the activation of TLR-2 and TLR-4, which play a role in the process of tuberculosis infection. The objective of this study was to investigate the effect of oral supplementation with vitamin D on TLR-2 and TLR-4 levels in tuberculosis spondylitis patients.

METHODS

The true Experiment Design Pretest-Posttest with Control Group (Pretest-Posttest with Control Group) was used for this research. TLR-2 and TLR-4 were measured by ELISA. Repeated ANOVA, ANOVA tests, and Kolmogorov-Smirnov normality tests on the SPSS program were used to statistically analyze the results.

RESULT

In the dose groups of 10,000 IU and 5000 IU, significant increases in the levels of vitamin D, TLR-2, and TLR-4 were observed at weeks 4 and 8 (p < 0.05). In the control group, there was no significant increase.

CONCLUSIONS

Vitamin D supplements can significantly increase TLR-2 and TLR-4 levels. Supplementation with vitamin D 10,000 IU/day for 8 weeks can increase vitamin D levels > 50 ng/dl to optimally act as an immunomodulator.

Radiological Outcomes of Reduction Surgery for Degenerative Lumbar Spondylolisthesis Using Long Arm Pedicle Screws

Objective

Until now, the spondylolisthesis reduction technique has relied on posterior instrumentation using long arm pedicle screws. In this way, the segments will be brought into alignment with the other vertebrae with the pedicle mats being tightened. The aim of this study is to acknowledge whether reduction surgery for degenerative lumbar spondylolisthesis (DLS) using long arm pedicle screws is able to correct the listhesis and spinopelvic parameters.

Methods

We carried out a retrospective study of patients with degenerative lumbar spondylolisthesis who went through reduction surgery using long arm pedicle screws in our institutions from January 2019 to March 2022. Preoperative and postoperative radiological outcomes consisting of listhesis and spinopelvic parameters were assessed.

Results

We found a statistical difference between the magnitude of listhesis immediately after surgery and preoperatively (p<0.001), with a successful correction of 85.85%. There was significant decrease in the value of pelvic tilt (p=0.044) and increase in the value of sacral slope (p=0.008) after surgery.

Conclusion

Reduction surgery using long arm pedicle screws for DLS was able to reduce the listhesis effectively up to 85.5%, and also to restore the parts of spinopelvic parameters, the pelvic tilt and sacral slope, approaching normal values.

Mast Cell Essential Roles: Will it be a Novel Tool for Differentiating the Severity of Pediatric Appendicitis?

BACKGROUND: Appendicitis is an undesirable diagnosis, and the Alvarado score (AS) alone is insufficient in recognizing it. Many novel laboratory indicators, such as leukocytes and mast cells, differentiate. AIM: Our objective was to demonstrate that mast cells had a greater influence on appendicitis severity than the AS, neutrophils, and platelets. MATERIALS AND METHODS: An observational research in which 35 individuals with acute appendicitis at our institutions were identified for the appendix grade and allocated to one of two groups: Complicated or non-complicated. The AS and white blood cell count were calculated using the neutrophil-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), thrombocyte-to-neutrophil ratio (TNR), and total leukocyte. Mast cell count and granulation are evaluated using pathological anatomy. RESULTS: TLR could not distinguish between severe appendicitis and others, but some showed potential. NLR, TNR, total leukocyte, ASs, mast cell count, and degranulation demonstrated good sensitivity-specificity values. CONCLUSIONS: Mast cells have the potential to become a promising approach for predicting complicated pediatric appendicitis.

Dayak Onions (Eleutherine americana L Merr) Reduced Mesothelial Cell Detachment After Laparoscopy in Rats

Background: Laparoscopy induces changes and detachment of mesothelial structure. Studies on the prevention of mesothelial cell detachment are rarely found. The Dayak tribe uses the Dayak onion (Eleutherine americana L. Merr) as a wound-healing agent due to its anti-inflammatory and antioxidant activities. This study aimed to prove the anti-inflammatory and antioxidant activities of Dayak onions in preventing mesothelial cell damage after laparoscopy. Materials and methods: Thirty male Sprague-Dawley rats were classified into five groups (n = 6 per group), namely: (a) control, (b) Mediclore, (c) Dayak onion, 30-, (d) 60-, and (e) 90 mg/kg body weight, respectively. The transforming growth factor-beta (TGF-β) and total oxidant status in the peritoneal fluid were determined 24 hours after laparoscopy. Histopathological analysis of mesothelial cell numbers and the protein Zone Occludin-1 (ZO-1) expression in the peritoneum, small intestines, greater omentum, and liver were performed 7 days after the procedure. An in-silico study was conducted to analyze the anti-inflammatory effects of the components of Dayak onions. Results: The in-silico study showed that one of the Dayak onion active compounds, eleutherine, had a potential anti-inflammatory effect and acted as a modulator of TGF-β. Following Dayak onion administration, the TGF- level, the number of mesothelial cell detachments, and ZO-1 expression were all significantly reduced (p<0.05), whereas the total oxidant status (TOS) level was not (p>0.05). Conclusions: Our study showed that Dayak onion administration reduced TGF-β level, number of mesothelial cell detachment, and ZO-1 expression following laparoscopy.

Laparoscopic procedures impact on mast cell mediators, extracellular matrix and adhesion scoring system in rats

Background

Laparoscopic procedures under certain pressure have the potential to cause intra-abdominal adhesions. However, the pathomechanism of this disorder is unknown. Release of mast cell mediators due to mast cell degranulation is thought to be the cause.

Materials and methods

Thirty male Sprague-Dawley rats were grouped into five groups (n = 6 per group): one control group and four intervention groups to which 60 min insufflation was performed using carbon dioxide at 5, 8, 10 and 12 mmHg. Seven days after laparoscopy, we euthanized and evaluated the levels of histamine, tryptase, and chymase of peritoneal fluid, the thickness of ECM of peritoneal tissue, and intraabdominal adhesion scoring system.

Results

Histamine and tryptase levels in peritoneal fluid were significantly higher at the 10- and 12 mm Hg intervention compared to control (histamine: 0.50 ± 0.35 vs. 0.41 ± 0.41 vs. 0.04 ± 0.02 ng/mL, respectively; and tryptase: 0.69 ± 0.11 vs. 0.65 ± 0.05 vs. 0.48 ± 0.02 ng/ml respectively). The ECM was significantly thicker in the intervention groups at 10- and 12-mm Hg compared to control (71.3 [66.7–85.2] vs. 48.4 [34.5–50.3] vs. 10.25 [8.7–12.1] μm, respectively). Moreover, the intra-abdominal scoring was also significantly higher in the intervention groups at 10- and 12 mm Hg compared to control (4 [0–4] vs. 4.5 [4–5], vs. 0, respectively).

Conclusions

Laparoscopic procedures increase the release of mast cell mediators in peritoneal fluid, the thickness of ECM and intraabdominal adhesion scoring in rats, implying that it might increase the possibility of intrabdominal adhesion in humans.

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Laparoscopic procedures at specific pressures potentially cause intra-abdominal adhesion, however, its pathomechanism is still challenging to understand.

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Laparoscopic procedures increase the release of mast cell mediators in peritoneal fluid, the thickness of ECM and intraabdominal adhesion scoring in rats.

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Our findings imply that laparoscopic procedures might increase the possibility of intrabdominal adhesion in humans.

The effect of laparoscopy on mast cell degranulation and mesothelium thickness in rats

Background

Laparoscopy induces adhesion due to ischemia-reperfusion injury. However, the detail pathomechanism is poorly understood. This study aimed to investigate the impact of laparoscopy on mast cell and mesothelium morphological changes in the rat.

Methods

Forty-nine males of Sprague-Dawley Rattus norvegicus were divided into four groups: a) control and b) intervention groups P1, P2, and P3 that underwent 60 min laparoscopic using carbon dioxide (CO₂) insufflation at 8, 10, and 12 mmHg groups, respectively. Serum hydrogen peroxide (H₂O₂), catalase (CAT), superoxide dismutase (SOD), malondialdehyde (MDA), and oxidative stress index (OSI) levels were determined 24 h after laparoscopy. Histopathological analyses of mast cell infiltration and degranulation and mesothelium thickness in the liver, greater omentum, mesenterium, small intestine, and peritoneum were performed 7 days after the procedure.

Results

H₂O₂, MDA, and OSI levels were significantly increased in the intervention groups compared with the control (p<0.05), while the SOD and CAT levels were decreased in the intervention groups compared with the control (p<0.05). Mast cell infiltration and degranulation were higher in the intervention groups than in control (p<0.05), while the mesothelium thickness was significantly lower in the laparoscopic groups than in control (p<0.05). Interestingly, the decrease in mesothelium thickness was strongly associated with the increase in mast cell infiltration and degranulation (p<0.01).

Conclusions

Our study shows that laparoscopy in rats increases mast cell infiltration and degranulation, which also results in and correlates with a decrease in mesothelial thickness.

Comparative Effectiveness and Functional Outcome of Open-Door versus French-Door Laminoplasty for Multilevel Cervical Myelopathy: A Meta-Analysis

BACKGROUND:

At present, few reports are comparing these 2 major cervical posterior laminoplasty methods with Open-door and French-door Laminoplasty in terms of neurological recovery, cervical alignment, and surgical complications. Moreover, most of the research has not been well designed.

AIM:

This study aims to determine comparative effectiveness and functional outcome of open-door versus french-door laminoplasty for multilevel cervical myelopathy.

METHODS:

The Meta-analysis is used in this study. The study sample is a published research articles on comparative effectiveness and functional outcome of open-door versus french-door laminoplasty for multilevel cervical myelopathy on the internet through databases on PubMed and ProQuest and published between 1997 until December 2018. Weighted mean difference and pooled weighted mean difference are calculated by using the fixed-effect model or random-effect model. Data is processed by using Review Manager 5.3 (RevMan 5.3).

RESULTS:

This study reviews 58 articles. There are 6 studies conducted a systematic review and continued with Meta-analysis of relevant data. The results showed significant higher postoperative Japanese Orthopaedic Association (JOA) score in open-door laminoplasty (ODL) than French-door laminoplasty (FDL) (weighted mean difference [WMD] = 0.71; 95% confidence interval [CI]: 0.35 to 1.07; p < 0.05). The outcome of procedures treatment of multilevel cervical myelopathy revealed the operative time, cervical range of motion, axial canal diameter postoperative, axial pain reduction and complications events in ODL and FDL there was no significant difference. But for a cervical lordotic angle in ODL and FDL, there was a significant difference; the ODL group were significantly lesser than the FDL group. The recovery rate in ODL and FDL, there was a significant difference; the ODL was shown to be significantly higher than FDL (p < 0.05).

CONCLUSION:

This analysis suggests that neither cervical laminoplasty approach is superior, based on the postoperative radiological data and complication rate. But the open-door laminoplasty resulted in a higher functional outcome and recovery rate as compared to the French-door laminoplasty.

Extraction the Dayak Onion (Eleutherine sp): Scientific Based Herbal Medicine (OHT) Production Protocol

Abstract: Indonesia has the second largest tropical forest and the richest in flora biodiversity in the world. Based on the Basic Health Research 2010, 59.29% of Indonesian had consumed herbal medicine, noted that Indonesian had consumed herb since the VIII century. Dayak onion (Eleutherine sp) widely used as traditional medicine, as a bahimang /wound healing agent. Dayak onion is not reassured as a medical treatment and lacked scientific evidence. Until 2018, thousands of herbs consumed by Indonesian, only 85 ingredients clinically tested. Sixty-four herbs have been pre-clinically tested and designated as Scientific based Herbal Medicines/Obat Herbal Terstandar (OHT) and 21 herbs have been tested clinically and determined as Phytopharmaca by the Badan Pengawasan Obat dan Makanan Republik Indonesia (BPOM-RI). Based on the data, the Dayak onion appointed as a Scientific based Herbal medicine (OHT) based on pre-clinical and phase 0 clinical research.  Potential and promising for the treatment of metabolic, degenerative, catastrophic, neoplasmic, genetic and infectious diseases, Dayak onions can be developed into phytopharmaca in the future. The study aim is to make guidelines for the standardized herbal medicines development according to the rules and regulations. Keywords: Dayak Onion, Eleutherine sp, Scientific based Herbal Medicines, Phytopharmaca, Pre Clinic and Clinical Trials phases

Orthopedic Case Burden at Nunukan Hospital: Focus On Trauma Case

Abstract: Incidence of orthopedic case is quite high in Nunukan Hospital, most of them need both non-operative and surgical intervention due to congenital, debridement, fracture, rupture of tendon and blood vessel, even amputation. Until now, data orthopedic case profile especially trauma case in Nunukan Hospital is not available. Also, the urgency of having an orthopedic surgeon is unbearable which unavailable in Nunukan, this made the management can’t be done comprehensively and as soon as possible. The aim of this research was to describe the incidence of orthopedic case at Nunukan hospital as basic data for further research. This Retrospective Study was conducted at Nunukan Hospital, North Kalimantan – Indonesia. The data is collected by using logbook and medical records during January 2016 - April 2017. Total of 231 cases were obtained. Male patients accounted for 73.6% (170 patients) and Female was 26.4% (61). The age ranged from 1 day to 82 years old. There are 8-21 cases happened per month (average: 14 cases). Based on case category, trauma occurred for 88.7%% (205). Five top diagnoses are; Close Fracture happened for 44.6% (103 cases), followed by Open Fracture 17.7% (41 cases), Lacerated wound 11.3% (26 cases), Traumatic Amputation 7.4% (17 cases) and CTEV 7.4% (17 cases). Most pathology within the period located in Foot for 29.9% (69). The multiple fracture, vascular, and soft tissue injury were observed. Orthopedic fractures were the most common injuries among patients with 88.7% in Nunukan Hospital from January 2016 to April 2017. There are 14 cases happened for each month with most of the patient were adult. Most of injuries happened at foot region.Abstract: Incidence of orthopedic case is quite high in Nunukan Hospital, most of them need both non-operative and surgical intervention due to congenital, debridement, fracture, rupture of tendon and blood vessel, even amputation. Until now, data orthopedic case profile especially trauma case in Nunukan Hospital is not available. Also, the urgency of having an orthopedic surgeon is unbearable which unavailable in Nunukan, this made the management can’t be done comprehensively and as soon as possible. The aim of this research was to describe the incidence of orthopedic case at Nunukan hospital as basic data for further research. This Retrospective Study was conducted at Nunukan Hospital, North Kalimantan – Indonesia. The data is collected by using logbook and medical records during January 2016 - April 2017. Total of 231 cases were obtained. Male patients accounted for 73.6% (170 patients) and Female was 26.4% (61). The age ranged from 1 day to 82 years old. There are 8-21 cases happened per month (average: 14 cases). Based on case category, trauma occurred for 88.7%% (205). Five top diagnoses are; Close Fracture happened for 44.6% (103 cases), followed by Open Fracture 17.7% (41 cases), Lacerated wound 11.3% (26 cases), Traumatic Amputation 7.4% (17 cases) and CTEV 7.4% (17 cases). Most pathology within the period located in Foot for 29.9% (69). The multiple fracture, vascular, and soft tissue injury were observed. Orthopedic fractures were the most common injuries among patients with 88.7% in Nunukan Hospital from January 2016 to April 2017. There are 14 cases happened for each month with most of the patient were adult. Most of injuries happened at foot region.

Cinnamomum burmanini Blume increases bone turnover marker and induces tibia's granule formation in ovariectomized rats

Background

Bone fragility and an increase in susceptibility to fracture osteoporosis is characterized by a reduction in bone mass and the micro-architectural deterioration of bone tissue. There is no previous study regarding the effect of Cinnamomum burmanini Blume on osteoporosis.

Objective

This study was aimed to investigate the effect of C. burmanini Blume on bone turnover marker, mineral elements, and mesostructure of ovariectomized rats.

Materials and methods

Thirty female Wistar rats were randomly divided into five groups, which included a control group (sham surgery), ovariectomy group (OVX), and ovariectomy groups in the presence of ethanolic extract of C. burmanini Blume (EECB) at doses of 12.5; 25; 50 mg/kg body weight (BW). Analysis of serum C-telopeptide collagen type I (CTX) and osteocalcin (OC) were done by enzyme-linked immunosorbent assay (ELISA). Tibia mineral elements and mesostructure were analyzed by X-ray Fluorescence and Scanning Electron Microscopy, respectively. In silico study was performed by modeling protein structure using SWISS-MODEL server and Ramachandran plot analysis.

Results

The increase in OC and CTX were significantly attenuated by treatments of EECB. Ovariectomy significantly decreased Cu/Zn ratio compared to sham-operated rats (p < 0.05). Mesostructure of ovariectomized rats was significantly different compared with the control group.

Conclusion

Cinnamon was able to normalize bone turnover markers, but, the mesostructure of hydroxyapatite crystal growth was achieved at the highest dose extract. In silico study showed that the active compound of EECB could not only support osteoclastogenesis process by decreasing the binding energy between RANKL and RANK, but also by inhibiting the interaction between OPG and RANK.

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Administration EECB significantly increased OC and CTX level compared to OVX group.

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The ratio of Cu/Zn was lower significantly in OVX rats compared to sham-operated rats.

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Hydroxyapatite crystal growth can reach at the highest dose of Cinnamon.

Effect of Lead Nanoparticles Inhalation on Bone Calcium Sensing Receptor, Hydroxyapatite Crystal and Receptor Activator of Nuclear Factor-Kappa B in Rats

This study aimed to investigate whether Pb nanoparticle exposure affects the bone calcium sensing receptor (CaSR), hydroxyapatite crystal, and receptor activator of nuclear factor-kappa B (RANK) in rats exposed to subchronic and chronic inhalation. Thirty two rats were randomly divided into eight groups. One group is a non-exposed group. While three groups were exposed to nanoparticles Pb at the following doses 6.25; 12.5; or 25 mg/m3 an hour daily for 28 days. Another three groups were exposed to nanoparticles Pb at following doses 6.25; 12.5; and 25 mg/m3 one hour daily for 6 months. The expression of trabecular CaSR was significantly decreased at the all doses subchronic exposure compared to the control group (P < 0.05). The CaSR expression significantly decreased in second and third doses subchronic exposure groups compared to the control groups (P < 0.05). With subchronic exposure, the crystal size was increased in second dose group and decreased in lowest and highest doses compared to the control (untreated) group. The crystal size and c-axis were decreased in all dose chronic exposures compared to the control (untreated) group. The expression of cortical RANK was significantly lower at the two lowest dose chronic exposures compared to the control group (P < 0.05). In conclusion, Pb nanoparticle inhibit hydroxyapatite crystal growth at least a part via down regulation of CaSR and RANK.

Pengaruh Insuflasi terhadap Jumlah Sel Mast Peritoneum Tikus

Abstract:Peritoneal insufflation is swelling process to perform laparoscopic surgery, the choice of gas for insufflation in laparoscopic surgery, namely CO2. because it is not flammable bleak N2O, so it can be used safely for diathermy in mice. This study aims to determine whether there is influence insufflation in an increased number of mast cells in rats (Rattus norvegicus). This study is pure experimental research with posttest-only control group design, which consists of the control and treatment of pressure 8 mmHg and 10 mmHg, with the results obtained p0 control = 0.52 p1 8 mmHg = 7.84  p2 10 mmHg = 11.94. ANOVA test showed that the increase in the number of mast cells was significantly occurred in the group with a pressure of 10 mmHg as compared to the pressure of 8 mmHg. Based on research carried out can be concluded that the higher the CO2 gas in the insufflation pressure significantly increases the number of mast cells.Keywords: insuflation, peritoneal, cell Mast Abstrak: Insuflasi adalah proses penggembugan peritoneum untuk melakukan pembedahan laparoskopi, pilihan gas untuk insuflasi pada bedah laparoskopi yaitu CO2. karena tidak mudah terbakar seprti N2O, sehingga dapat digunakan secara aman untuk diatermi pada tikus. Penelitian ini bertujuan untuk mengetahui apakah ada pengaruh insuflasi dalam peningkatan jumlah sel mast pada tikus putih (Rattus norvegicus). penelitian ini merupakan penelitian experimental murni dengan posttest-only with control group design, yang terdiri dari kontrol dan perlakuan dengan tekanan 8 mmHg dan 10 mmHg, dengan hasil yang didapatkan p0 kontrol = 0,52 p1 8 mmHg = 7,84 p2 10 mmHg=11,94. Uji anova menunjukan bahwa peningkatan jumlah sel mast secara bermakna terjadi pada kelompok dengan tekanan 10 mmHg dibandingkan dengan tekanan 8 mmHg. Berdasarkan penelitian yang dilakukan dapat diambil kesimpulan bahwa semakin tinggi tekanan gas CO2 pada insuflasi secara bermakna dapat meningkatkan jumlah sel mast. Kata-kata Kunci :Insuflasi, sel mast, peritoneum

Regulation by Phloroglucinol of Nrf2/Maf-Mediated Expression of Antioxidant Enzymes and Inhibition of Osteoclastogenesis via the RANKL/RANK Signaling Pathway: In Silico study

Introduction:

Phloroglucinol is an antioxidant compound with many positive effects on health. The purpose of this study was to determine the role of phloroglucinol in osteoclastogenesis via the RANKL/RANK signaling pathway and the activity of the transcription factor Nrf2.

Material and methods:

Analysis was performed in silico using the primary method of docking by the use of Hex 8.0 software and Haddock web server. Analysis of interactions was then performed to determine interactions between the ligand and its receptors by using the software LigPlus and LigandScout 3.1.

Results:

Results indicated that phloroglucinol compound was thought to inhibit osteoclastogenesis via three mechanisms: inhibiting RANKL−RANK interaction, sustaining the RANKL−OPG bond, and increasing the activity of the transcription factor Nrf2.

Tibia bone properties at different time course of ovariectomized rats

BACKGROUND

The model of bilaterally ovariectomized rats mimics the accelerated bone loss observed in postmenopausal women due to estrogen deficiency. Although calcium is main mineral in bone, previous study in human showed there is hypermineralization and higher calcium level in hydroxyapatite crystal structure from osteoporosis patients. This study was aimed to investigate the effect of time course ovariectomized on tibia bone turn over markers, mineral elements, hydroxyapatite crystale, mesostructure, and histomorphometry.

METHODS

A total of 30 Wistar female rats were randomly assigned into three groups (n = 10 each): control group, ovariectomy group follow up for one month and two month. All animals procedures was according to Animal Ethics Guidelines and approval by ethic committee of the Medical Faculty, Lambung Mangkurat University which obtained prior the study. Expression of osteocalcin (OC) and C-telopeptyde collagen type I (CTX) was analyzed by ELISA method. Tibia bone mineral element was measured using X-Ray Fluorescence. Hydroxyapatite crystale structure was analyzed using X-Ray Diffracttion. Mesostructure was determined using Scanning Electron Microscope. Histomorphometry was analyzed using BoneJ software analyzer. ANOVA test was used to analyze the different level of serum bone turnover markers and bone mineral elements.

RESULTS

Serum OC and CTX were significantly decrease in one month and two month after ovariectomized groups compared to sham-operated group (P < 0.05). The levels Ca, P, Fe, Cu, Zn, Ni, Ca/P, and Cu/Zn were not significantly different in all groups (P > 0.05). The structure of hydroxyapatite crystal in one month and two month after ovariectomized groups were different compared with sham-operated control group. Mesostructure of tibia bone after one and two month ovariectomized procedure significantly different than that in sham-operated rats. The level of trabecular volume were lower significantly on OVX-1 and OVX-2 groups compared with sham group (P < 0.05). The trabecular thickness and spacing were increase significantly on OVX-1 and OVX-2 groups compared with sham group (P < 0.05). The trabecular number were significantly decrease OVX-1 and OVX-2 groups than that sham group (P < 0.05).

CONCLUSION

We found that two month after ovariectomized decrease serum osteocalcin but not change bone mineral elements in rats. Also, we found the difference of lattice parameter of hydroxyapatite crystale structure and trabecular properties which determined bone mesostructure.

Labor outcome of primigravidae in Mymensingh Medical College Hospital

This cross sectional study was done in the department of Obstetrics and Gynae, Mymensingh Medical College Hospital, during the period 1st January to 30th June 2000 to evaluate the labor outcome in primigrvidae women. Total 1250 cases were delivered in this period. Among all 500(40%) were primigravidae. All the primigravidae were included and labor was monitored and managed by close observation. Condition of the baby was determined by applying APGAR (Appearance, Pulse, Grimace, Activity and Respiration) score. Maximum (66.6%) of patients were belonged to 21-29 years age group. Only few 28.2% had regular antenatal check-up. Risk factors were present in 32% cases. Common risk factors were PET (Pre-eclamptic toxemia) and eclampsia. Mode of deliveries were normal vaginal delivery (NVD) in (51.6%) cases, Lower Uterine Caesarean section (LUCS) in 43.8% cases, Ventouse in 2.8% cases, Forceps in 9(1.8%) cases and craniotomy was required in 2(0.4%) cases. Complications during labor were prolonged labor, postpartum hemorrhage, obstructed labor and perineal tear. PET was common (29.62%) in age group 30-36 years and eclampsia was more common (15%) in age group 16-20 years. NVD were more (55.85%) in 21-29 years group than other age group. The duration of labor pain was short in the age group of 21-29 years and was prolonged in the age group 30-36 years. Maternal mortality was 1.6% (8) cases. Causes of death were septic shock, renal failure and Cerebrovascullar accident. Morbidities after delivery were hypertension, wound infection, puerperal psychosis, acute renal failure, vesicovaginal fistula, hypertensive retinopathy, chronic ill health and retention of urine. Among 500 cases 92.6% were live born and 7.4% were still born. Among total cases 81.6% babies were healthy, 6.8% were asphyxiated, 71.2% had normal birth weight 21.4% had low birth weight, 18% were premature and 7.4% were IUGR. This study shows the safest and easiest delivery age group of primigravidae is between 21-29 years. Maternal mortality and early neonatal death are still holding high rate.

Expression, purification, and evaluation of recombinant LecA as a candidate for an amebic colitis vaccine

Entamoeba histolytica, which causes amebic colitis and liver abscess, is considered a major enteric pathogen in residents and travelers to developing countries where the disease is endemic. Interaction of this protozoan parasite with the intestine is mediated through the binding of the trophozoite stage to intestinal mucin and epithelium via a galactose and N-acetyl-d-galactosamine (Gal/GalNAc) lectin comprised of a disulfide linked heavy (ca. 180 kDa) and light chain (ca. 35 kDa) and a noncovalently bound intermediate subunit (ca. 150 kDa). Our efforts to develop a vaccine against this pathogen have focused on an internal 578 amino acid fragment, designated LecA, located within the cysteine-rich region of the heavy chain subunit because: (i) it is a major target of adherence-blocking antibodies of seropositive individuals and (ii) vaccination with his-tagged LecA provides protection in animal models. We developed a purification process for preparing highly purified non-tagged LecA using a codon-optimized gene expressed in Escherichia coli. The process consisted of: (i) cell lysis, collection and washing of inclusion bodies; (ii) solubilization and refolding of denatured LecA; and (iii) a polishing gel filtration step. The purified fragment existed primarily as a random coil with β-sheet structure, contained low endotoxin and nucleic acid, was highly immunoreactive, and elicited antibodies that recognized native lectin and that inhibited in vitro adherence of trophozoites to CHO cells. Immunization of CBA mice with LecA resulted in significant protection against cecal colitis. Our procedure yields sufficient amounts of highly purified LecA for future studies on stability, immunogenicity, and protection with protein-adjuvant formulations.

Atomic mineral characteristics of Indonesian osteoporosis by high-resolution inductively coupled plasma mass spectrometry

Clinical research indicates that negative calcium balance is associated with low bone mass, rapid bone loss, and high fracture rates. However, some studies revealed that not only calcium is involved in bone strengthening as risk factor of fracture osteoporosis. Thus, in this report, the difference of metallic and nonmetallic elements in osteoporosis and normal bones was studied by high-resolution inductively coupled plasma mass spectrometry (HR-ICP-MS). The influence of these elements on bone metabolic processes is also discussed. Inclusion criteria of bone samples consist of postmenopausal woman, trabecular bone fracture, normal and osteoporosis BMD value, and no history of previous disease. The results showed that the concentration of B, Al, S, V, Co, Mo, Te, Ba, La, Ni, As, and Ca/P ratio is higher in osteoporosis than normal. These atomic minerals have negative role to imbalance between bone resorption and bone formation activity. Conversely, concentrations of Na, Mg, P, K, Ca, Cr, Pd, Ag, Mn, Fe, Cu, Zn, Rb, Sr, Pb, and Se are lower in osteoporosis than in normal bones. Among these atoms, known to have important roles in bone structure, we found involvement of atomic mineral and calcium which are considerable to contribute to osteoporotic phenomena.

Histopathological analysis of hysterectomy specimens

The objective of this study was to explore the histopathological findings and the rate of removal of ovaries in hysterectomy specimens. This study took into account 328 hysterectomy specimens examined in the Department of Pathology, Mymensingh Medical College and in one private Pathology Laboratory in Mymensingh town from March to August, 2005. Formalin fixed paraffin embedded tissue sections stained with haematoxylin and eosin were examined under light microscope. Patients' age, parts of uterus examined and their histopathological findings were retrieved from laboratory records. The common histopathological findings were: chronic cervicitis (87.80%), leiomyoma (17.07%), uterine prolapse (16.72%), adenomyosis (3.96), non-specific endometritis (3.35%), squamous cell carcinoma of cervix (2.44%), endometrial polyp (2.44%), serous cystadenoma of ovary (2.44%) and endometrial hyperplasia (1.83%). Some of the specimens show more than one lesions in the body of uterus, of which coexistence of adenomyosis and leiomyoma was the most common. Neoplastic lesions in cervix were 4.27%, in body 16.92% and in ovaries 5.06%. Malignant neoplasms were found in cervix 71.43%, in uterine corpus 3.03% and in ovaries 25%. Ovaries of both sides were removed in 48.17% of total cases. Their median age was 45 years, lowest age 23 years and maximum age was 82. The rate of removal of both ovaries was found to be increasing with the increase of age. Only one case was found to be subtotal hysterectomy and others were total hysterectomy. The present study revealed that the most common histopathological cause of hysterectomy is chronic cervicitis. Most common neoplastic cause of hysterectomy is leiomyoma. The rationalities and the possible after effect of hysterectomy in sexual functions and other physiological impairment should be followed up.