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Het gaat dan vooral om onbeschermd seksueel contact met penetratie (penis in vagina en penis in anus). Als de moeder het hepatitis B-virus in het bloed heeft, is de kans groot dat zij het virus tijdens de zwangerschap of bij de bevalling doorgeeft aan haar kind. Overdracht van het hepatitis B-virus komt ook voor tussen gezinsleden in een gezamenlijk huishouden of onder personen in een instelling. Bij chronische actieve hepatitis B veroorzaakt het hepatitis B-virus een langdurige (chronische) ontsteking in de lever.
De vaccinatie bestaat uit drie injecties waarbij de tweede een maand na de eerste vaccinatie wordt gegeven en de derde vijf maanden na de tweede vaccinatie. Hepatitis C is de benaming voor een leverontsteking door infectie met het hepatitis C-virus. Bij acute hepatitis B is het belangrijk dat seksuele partners op de hoogte worden gebracht en zich ook laten testen.
METHODS: Sixty rats were randomly divided into a normal control group (group A, n=10) and a Vibrio vulnificus sepsis group (group B, n=50).
CONCLUSION: Vibrio vulnificus sepsis can lead to injury in rat lungs, and increased HMGB1 expression in lung tissue may be one of the mechanisms for injury from Vibrio vulnificus sepsis. Sixty Sprague-Dawley rats, 30 males and 30 females, weighing 180-260 g, were provided by the Life Sciences Laboratory of Wenzhou Medical College, Zhejiang, China.
Fluid was extracted from hemorrhagic blisters of the lower limbs of patients with Vibrio vulnificus infection. The rats were fed for 1 week, then fasted for 12 hours before the experiment, but they were allowed free access to water. Microscopic study of group A showed marked alveoli, thin alveolar septum and no congestion or edema (Figure 3). According to other reports, HMGB1 as a DNA binding protein is found extensively in eukaryotic cells.
Funding: This work was supported by grants from Zhejiang Medical Key Construction Subject Project (07-F04), Zhejiang Science and Technology Plan Project of Chinese Medicine (2007CA085), Wenzhou Municipal Science and Technology Plan Project (Y20080088). I was interested in studying this type of injury because it is said that the femur break is the most painful bone break in the entire body. Tip: To turn text into a link, highlight the text, then click on a page or file from the list above.
We report a 45-year-old male archer with stress fracture in his left ulna on the background of adult type of hypophosphatasia. We reported a male archer who had diagnosis of hypophosphatasia and presenting with stress fracture on his ulnar bone following complaint of pain around the left elbow. A 45-year-old professional archer presented to our outpatient clinic with complaint of pain being more intense around his left elbow and radiating to the left wrist.
On the physical examination, there was tenderness with pressing on the midproximal ulnar region. Figure 2: Anteroposterior and lateral X-rays showing stress fracture in proximal metaphysis of left ulna. Figure 3: Coronal sections showing stress fracture line and surrounding soft tissue oedema in T1 and T2 sequences of the patient’s forearm MRI.
Arm sling was recommended to the patient and he was asked to suspend his sportive activities for 6 weeks. Although ulnar stress fractures have been reported for several sportive branches in the previous works, we did not find forearm stress fracture developing on the background of hypophosphatasia in the literature. Stress fractures on the nonweight bearing bones may be easily confused with pathological fractures if the clinical course of the patient is not obvious and the patient has a history of malignancy in another site.
Since there was no pathological or metabolic problem, the possible mechanism was considered to be a combination of excessive axial force occurring during forced extension and de-rotational force occurring to avoid release of the arch [3–5].
In conclusion, diagnosis of stress fracture should absolutely be considered for pain on the forearm or around the elbow in the athletes excessively using their arms and frequently exposing to them tractional-rotational forces. Our community has been started to provide resources related to orthopedics for surgeons,residents,medicos and patients. Overdracht vindt plaats door contact van sperma en vaginaal vocht met slijmvliezen van de partner. Hoewel het hepatitis B-virus ook in speeksel voorkomt, raakt iemand niet door tongzoenen besmet. Infectie komt ook voor via niet hygienische accupunctuur, tatoeage en piercing of door het gemeenschappelijk gebruik van scheermesjes en tandenborstels.
Als bekend is dat de vader drager is van het virus en de moeder niet, wordt eveneens een volledige vaccinatie van de baby aangeraden. Dit virus komt via de mond en het maagdarmkanaal in de lever terecht en veroorzaakt daar een ontsteking. The lung is one of the earliest organs affected by sepsis associated with acute lung injury. It was inoculated into blood agar plates to culture and purify Vibrio vulnificus at 37 °C for 24 hours. The tissue specimens were transferred to the oven at 60 °C for 48 hours to a constant weight and dry weight.
These changes were used as a reference to compare the changes in group B at each time point.
Pathological changes in the lung tissues of group B 1 hour and 6 hours after Vibrio vulnificus infection were not significant as compared with group A (Figure 3). It causes the release of a large number of inflammatory mediators and other injury factors. Its functions include stable nucleic acid structure, t ranscr ipt ional regulat ion and gene expression.
Dynamic expression of liver tissue apoptosis related genes in Vibrio vulnificus sepsis rats and effects of antibacterial agents.

Necrotizing fasciitis caused by Vibrio vulnificus: epidemiology, clinical findings, treatment and prevention. The dynamic change in the expression of interleukin 18 mRNA in the tissue of scalded rats after delayed resuscitation. Advances in high mobility group box-1 protein mediated multiple organ dysfunction and its potential interventional strategies.
Effect of antimicrobial agents on the toll-like receptors and inflammatory cytokines in liver tissue of the alcohol-induced liver disease in rats with Vibrio culnificus sepsis. Effects of antimicrobial agents on the Toll like receptors and myeloid differentiation protein-2 in liver tissue of alcohol-induced liver disease: experiment with rats. Changes of toll-like receptor, TNF-alpha and IL-10 in liver tissue of rats before and after intragastric infusion with alcohol with Vibrio vulnificus sepsis. Adenovirus-mediated gene transfer of tissue factor pathway inhibitor induces apoptosis in vascular smooth muscle cells. Role of Toll-like receptor 4 for the pathogenesis of acute lung injury in Gram-negative sepsis.
Regulation of inflammatory responses by sensory neurons: molecular mechanism(s) and possible therapeutic applications. It may not display this or other websites correctly.You should upgrade or use an alternative browser. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The patient presented to several medical centers for pain around the left elbow and received medical treatment upon diagnosis of tenosynovitis. The risk of fracture further increases in presence of a systemic condition reducing bone quality such as hypophosphatasia [1]. Active and passive pronation-supination movements were aggravating the pain although the range of motion (ROM) was full on the elbow.
Additionally, fractures of the metaphysis are rare although they are usually seen on middiaphysis of the ulna [2].
Thus for these patients, history should be taken carefully and detailed physical examination should be done.
No pathological lesion (soft tissue or bone tumor, periosteal reaction, etc.) was observed that might cause fracture on MRI scanning and the fracture was progressing in the process of healing without complication. However, risk of fracture further increases in the presence of systemic conditions reducing quality of bone such as hypophosphatasia. Iemand is dan niet meer besmettelijk en bovendien beschermd tegen een eventuele nieuwe besmetting met het hepatitis B-virus.
Iemand met een chronische infectie (ook wel ‘drager’ genoemd) is nog wel besmettelijk voor anderen. High mobility group protein B1 (HMGB1) is an important late-acting pro-inflammatory cytokine involving in the pathophysiology of sepsis. The rats in group B were sacrificed separately 1, 6, 12, 24, and 48 hours after the infection.
The role of HMGB1 in tissue and organ injury has been reported that it is involved in the tissue and organ injury process in the lung, liver and intestine.[5,6] In this study we established a Vibrio vulnificus sepsis model in rats and observed HMGB1 expression, lung water content and dynamic histopathological changes in the lung tissue.
After electrophoresis, images of PCR products were generated by a gel imaging system and were analyzed by Gelpro32 analysis software. After polyacrylamide gel electrophoresis in an ice-water bath, the membrane was transferred at 320 mA in an ice-water bath for 35 minutes and sealed at room temperature for 90 minutes. However, 12, 24 and 48 hours after the infection, group B showed significant pulmonary vascular congestion, local bleeding, and pulmonary interstitial edema associated with inflammatory infiltration. HMGB1 can be secreted into the extracellular space and acts as an important late-acting pro-inflammatory cytokine involving in the pathogenesis of sepsis. The increase in HMGB1 expression could be one of the mechanisms for lung injury in rats with Vibrio vulnificus sepsis. History of the patient revealed that he had had diagnosis of hypophosphatasia ten years ago and underwent percutaneous screwing for stress fracture on both of his femoral necks. History of the patient revealed that he had diagnosis of hypophosphatasia ten years ago and underwent percutaneous screwing for stress fracture on both of his femoral necks (Figure 1). On anteroposterior and lateral radiographies, nonsegmented fracture line was seen on the proximal left ulna beginning from the medial cortex and extending to the lateral cortex (Figure 2).
We reported here a patient with hypophosphatasia who developed stress fracture on his proximal ulnar metaphysis following long trainings of archery. Since the original case, many cases with stress fracture of ulna have been reported in several sportive branches such as tennis, weight lifting, baseball, and polo [8–12]. Additionally, MRI scanning should be performed in the area and scintigraphic scanning may be done in suspicious cases.
Therefore, carefully querying history of the patient may enable early initiation of the treatment as well as avoid serious disabilities that may develop. Rettig, “Stress fracture of the ulna in an adolescent tournament tennis player,” American Journal of Sports Medicine, vol. Hamilton, “Stress fracture of the diaphysis of the ulna in a body builder,” American Journal of Sports Medicine, vol. Their lungs were stored as specimens, lung water content was measured, and lung pathology was observed under a light microscope. Compared to group A, pathological changes at 12 hours in group B indicate marked pulmonary vascular congestion, interstitial edema and inflammatory infiltration. We also investigated the dynamic expression of HMGB1 in the lung tissue of rats with Vibrio vulnificus-induced sepsis so as to understand the pathogenesis of Vibrio vulnificus sepsis. The rats of the Vibrio vulnificus sepsis model group (group B, n=50) were injected subcutaneously with Vibrio vulnificus suspension in the left lower limbs. The boundaries of the alveolar septum could not be clearly identified, and significant alveolar collapse and more severe edema were observed (Figure 3).

A large number of pro-inflammatory cytokines can lead to pulmonary vascular endothelial injury and increased pulmonary vascular permeability, which are important causes of lung injury.[13] The results of this experiment showed that the water content of the lung tissue of rats with Vibrio vulnificus sepsis increased gradually after Vibrio vulnificus infection. Upon finding nondisplaced stress fracture on proximal metaphysis of the ulna on X-ray, the patient underwent magnetic resonance imaging (MRI) in order to exclude pathological causes.
Cases with stress fracture in the forearm have been reported in the athletes of basketball, weight lifting, baseball, or arms drill although it is usually reported to be unilateral [1–6]. The patient had taken analgesics at the beginning of his complaints but presented to several hospitals upon worsening of his pain.
Stress fracture was suspected because there was no finding on the physical examination to suggest presence of infection and the patient had no history of trauma. The first manifestation is foot pain that may develop due to stress fracture on the metatarsals. Perez Carro, “Stress fracture of the ulna associated with crutch use,” Journal of Orthopaedic Trauma, vol.
Moller, “Fractures of apparently healthy bone without unquestionably true element of accident,” Acta Chirurgica Scandinavica, vol.
Shinozuka, “Bilateral stress fractures of the ulnae in a Kendo (Japanese fencing) player,” British Journal of Sports Medicine, vol. There has been no report on the involvement of HMGB1 in Vibrio vulnificus sepsis-induced lung injury. The expressions of the HMGB1 gene and protein in the lungs were detected by RT-PCR and Western blot. Alveolar cavity collapse and boundaries of the alveolar septum could not be clearly identified. Similarly, the histopathological changes of the lung increased progressively, but they were not significant during the early phase. HMGB1 can further stimulate monocytes to secrete other pro-inflammatory cytokines TNF-α, IL-1 and IL-6.
He did not have radiological examination in those centers and had medical management with several diagnoses such as tenosynovitis, epicondylitis, and myalgia. MRI examination was performed to exclude other pathological causes although the patient had history of hypophosphatasia. Stress fractures occurring on the diaphysis or upper end of the femur may cause pain on the thigh or hips. When the patient has been seen in the clinic, assays of calcium, phosphorus, parathyroid hormone, vitamin D, and bone densitometry may be helpful for investigating metabolic conditions. Brukner, “Stress fracture of the ulna in a baseball pitcher,” Clinical Journal of Sport Medicine, vol.
Data were analyzed with one-way analysis of variance (ANOVA) and the LSD method for pair-wise comparison between the two groups. Rabbit anti-rat HMGB1 antibodies and mouse anti-rat HMGB1 antibodies were purchased from Abcam in the USA. The rat Vibrio vulnificus sepsis model was described previously.[7,8] The rats in group B were sacrificed after anesthesia at 1, 6, 12, 24 and 48 hours after infection.
In the mid to late phase, pulmonary vascular congestion, local bleeding, severe pulmonary edema, and alveolar collapse could be clearly observed. The inflammatory cascade continues and eventually leads to an uncontrolled inflammatory response and the occurrence of MODS. The patient’s sportive activities were restricted for 6 weeks and he received conservative management with arm slings. On MRI scanning, there was a linear fracture line suggesting stress fracture at the level of proximal metaphysis of ulnar bone along with edema in surrounding soft tissues including medulla of the fracture (Figure 3). Frequently, lower extremity stress fractures have been observed especially on the metatarsals.
Endocrinology consultation must be absolutely performed even though no abnormality is found in the investigations. Slauterbeck, “Stress fracture of the ulna in a male competitive polo player,” American Journal of Sports Medicine, vol. Lung tissue water content and pathological changes indicated that lung injury was more severe as the disease progressed, particularly in the mid and late phases. Adult type of hypophosphatasia is a disease manifesting with widespread osteoporosis and presenting with low serum level of alkali phosphatase (ALP).
Except for localized pain, he had no pathological motor or sensorial examination findings to suggest neurovascular conditions.
Laboratory investigations and required consultations were made because of history and age of our patient. Briggs, “Ulnar stress reaction from crutch use following amputation for tibial osteosarcoma,” Skeletal Radiology, vol. Parts of the lung tissues were collected sterilely, rinsed with normal saline at 4 °C, and then stored immediately in liquid nitrogen for later use. The results of this experiment showed that HMGB1 mRNA expression in the lung tissue of rats with Vibrio vulnificus sepsis peaked in the mid and late phases and maintained a relatively high level in the late phase. Stress fracture should definitely be considered in the patients with history of hypophosphatasia and refractory extremity pain.
We consider that the reason for this was that the patient was an archer and torsional force was so much on his arm [1]. It also confirmed that HMGB1 acted as a late-acting pro-inflammatory cytokine involving in the pathophysiology of sepsis.[16] HMGB1 expression and injury to the lung tissues of rats with Vibrio vulnificus sepsis showed significant pathological changes in the mid and late phases, suggesting a relationship between HMGB1 expression and lung tissue injury.

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