Acute Appendicitis in Pediatric Patients With Sickle Cell Disease: Lower Incidence,More Imaging,and More False-Positives

ObjectivePatients with sickle cell disease (SCD) experience recurrent pain crises, which may mimic appendicitis. A prior study found a significantly lower rate of appendicitis in patients with SCD compared with national averages. We investigate the incidence of appendicitis and number of imaging studies for appendicitis in pediatric patients with SCD.MethodsUsing a retrospective study design from a single institution, SCD and control cohorts were created. Inclusion criteria included age 0 to 21years and at least one follow-up appointment within 24 months. Length of observation was calculated from initial presentation to either inpatient admission for appendicitis or last clinic visit. Analysis of an SCD subgroup and a control subset (n = 1,596) was used to compare the number of imaging studies. Incidence rates of appendicitis and number of appendicitis studies were determined. Z-tests, binomial enumeration exact tests, and Fischer’s exact tests were used.ResultsThe SCD cohort included 1,064 patients between January 1, 2001, to December 31, 2014, and the control cohort included 115,109 patients without SCD between January 1, 2011, and December 31, 2011. Incidence rate of appendicitis per 10,000 patient-years was significantly lower in the SCD group compared with controls (2.9 cases versus 10.7 cases per 10,000 patient-years; P = .044). Additionally, the SCD group received significantly more ultrasounds (148 versus 60 per 10,000 patient-years; P < .0001) and CTs (94 versus 27 per 10,000 patient-years; P < .0001) for appendicitis, which remained significant when controlling for race. Patients with SCD also received more false-positive scans.DiscussionPatients with SCD had a significantly lower incidence of appendicitis than controls, yet had a higher number of imaging tests performed for appendicitis. Appendicitis should be viewed as a less common cause of acute abdominal pain in SCD. This consideration should help guide imaging strategy.     

Y-chromosomal microsatellite mutation rates in a population sample from northwestern Germany

To estimate Y-chromosomal short tandem repeat (Y-STR) mutation rates, 15 loci (i.e., DYS19, DYS389 I/II, DYS390, and DYS393; DYS437, DYS438, DYS439, and DYS385; DYS391, DYS392, YCA II, and DXYS156) were analyzed in a sample of 1,029 father/son pairs from Westphalia, northwestern Germany. Among 15,435 meiotic allele transfers, 32 mutations were observed; thus, the mutation rate across all 15 Y-STR loci was 2.1 × 10⁻³ per locus (95% C.I.: 1.5–3.0 × 10⁻³). With the exception of a three-repeat mutation at DYS385, all remaining mutations were single repeat mutations. Repeat losses were more frequent than gains (20:12), and the mutation rate appeared to increase with age. The Y haplogroups that were detected in the individuals showing a mutation reflect the haplogroup distribution in the Westphalian population. Additionally, the correlation of surnames and haplotypes was tested: Only 49 surnames occurred more than once, and only two men with the same rare surname shared the same haplotype. All other men with identical surnames carried different haplotypes. Electronic supplementary material Supplementary material is available in the online version of this article at and is accessible for authorized users.     

A prospective cohort study of injury in amateur and professional boxing

Background

There is concern over the potential for a high incidence of injury in boxing. This is despite a lack of prospective data evaluating the risk for modern day participants. Updated, reliable data with a focus on potential exposure to injury for both amateur and, especially, professional boxers is required.

Aim

To determine the epidemiology of injury and exposure of amateur and professional boxers in Victoria, Australia.

Methods

A prospective cohort study with one year follow up was carried out over 2004–2005. Thirty three amateur and 14 active professional boxers registered with either Boxing Victoria Inc (amateurs) or the Professional Boxing and Combat Sports Board of Victoria (professionals) volunteered. Exposure at training and competition was measured, and any injuries sustained during this participation were recorded.

Results

Twenty one injuries were sustained by the cohort during the follow up period. Most were to the head region (71%; 95% confidence interval −3.7 to 89.4), with concussion being the most common (33%). An overall injury rate of 2.0 injuries per 1000 hours of boxing was calculated.

Conclusion

The high exposure experienced by the boxers (as a result of considerable training time) indicated that boxing has acute injury rates comparable to, and often lower than, those found in other contact and non‐contact sports. Further, acute injuries during training appear to be less common and severe than those sustained in bouts.     

More guns,more death

It is contended that easier access to small arms increases the likelihood of misuse, on the basis of evidence comparing rates of firearm mortality and availability both between comparably developed countries, contrasting particularly the United States and others, and in different regions of individual countries. For example, firearm mortality is often greater in rural areas than urban. Possible inaccuracies in data collection are considered, but felt not sufficient to account for the finding. Measures to restrict availability such as stricter licensing, regulations governing storage and legally‐imposed ‘gun‐free zones’ may all reduce the death toll. In conflict zones, measures to remove arms post‐conflict reduce subsequent mortality. Breaking the supply chain is also important and the link between supply, demand and the values of a society must be kept in mind.     

影响腹部创伤患者损害控制手术后生存率的相关因素分析

目的探讨影响实施损害控制手术（DCS）腹部创伤患者生存率的相关因素。方法回顾性分析27例实施DCS患者的临床资料,比较存活组和死亡组病人的术前一般情况、ISS、手术方式、治疗情况及各种围手术期生命体征、器官功能变化情况,最后采用多因素Logistic回归分析影响患者生存率的相关预后因素。结果影响DCS患者术后生存率的因素包括年龄、ISS、术前体温和碱剩余（BE）值、估计失血量、ICU入室体温以及住院时间（P〈0．05）;其中,年龄增长、术前BE绝对值增加和ICU入室体温降低是预测DCS术后患者生存率的独立预后因素（P〈0．05）。结论DCS有助于提高严重腹部创伤患者术后生存率,年龄增长、术前BE绝对值增加和ICU人室体温降低是影响生存率的独立预后因素。     

Quantifying the risk of sports injury: a systematic review of activity-specific rates for children under 16 years of age

Injuries caused by sports and other forms of physical activity in young children constitute a significant public health burden. It is important to quantify this risk to ensure that the benefits of sport participation are not outweighed by the potential harms. This review summarises the literature reporting exposure-based injury rates for various forms of physical activity in children aged 15 years and younger. Forty eight studies were found, of which 27 reported injury rates per hourly based exposure measured and 21 reported injury rates according to some other measure. Fourteen different sports and activities were covered, mostly team ball sports, with soccer being the most widely studied. Injury definition and the method of ascertaining and measuring injuries differed between studies, which created a large variation in reported injury rates that did not necessarily represent actual differences in injury risk between activities. The highest hourly based injury rates were reported for ice hockey, and the lowest were for soccer, although the range of injury rates for both of these activities was wide. Very few studies have investigated sports-related injuries in children younger than 8 years or in unorganised sports situations.     

Transition from lorentzian to gaussian line shape of magnetization transfer spectrum in bovine serum albumin solutions

Magnetization transfer experiments using an off-resonance irradiation technique were performed on bovine serum albumin solutions by varying the irradiation frequency and the concentration. A transition of the magnetization transfer spectrunr from Lorentzian to Gaussian line shape was observed around the critical concentration of 6.2 mmoles of protein to kg ad solution. Observed magnetizations were well expressed by the rate equations of populations for spins below and above the transition, which yielded the magnetization transfer rates, the intrinsic relaxation rates of both protein and water protons, and the effective tumbling time and the rigid line width of the protein. The result showed that the estimates of the values for magnetization transfer rate do not change once the critical concentration is reached.     

影响奶牛配种受胎率的因素及应对措施

牛场奶牛繁殖率的高低,直接影响牛场的生产效率和经济效益。奶牛情期受胎率的高低受诸多因素的影响,因此提高奶牛的情期受胎率是牛场繁育工作的重中之重。本文将多年牛场奶牛繁殖工作的经验进行整理和总结,希望能对牛场从事繁殖工作的同行们解决类似问题提供借鉴和参考。牛场繁殖工作人员要保证奶牛有较高的受胎率,必须严抓围产期奶牛的饲养管理、营养水平、健康状况、奶牛场生产环境、人工授精操作水平等环节,并能在日常工作中及时对发情牛进行准确无误的鉴定和适时进行人工授精。通过大量的实践经验总结得出,奶牛在发情已经结束的3.5 h内进行人工授精,其情期受胎率最高,可以达到75.39%(193/256);为了及时的将发情母牛检出,每天进行发情观察3~4次,每次至少观察40min以上,两次间隔不超过8 h,这样发情母牛的检出率可以达到85%以上。     

Estimation of in vivo proton intrinsic and cross-relaxation rates in human brain

By using on-resonance binomial pulse saturation of the immobile component in tissues and by monitoring the time development of the longitudinal decay of the free water magnetization, it has been shown that it is possible to estimate physical model parameters not directly measurable by conventional methods. Since pulsed saturation is easy and safe to implement in a clinical MRI machine, it should be possible to estimate these parameters in vivo by the same means. In this article, we report the results of such estimates of the parameters of the principal components (gray and white matter) in brains of two normal volunteers.     

新型宽域X线增感屏的研制

目的　常规胸片上 ,在不改变投照条件下 ,使脊柱、纵隔、心后肺内占位病灶和两侧肺野内细小病变 ,均能清晰地显示在同一张照片上。方法　通过对现有增感屏的增感物质在布局上加以改变和技术处理 ,即中央部分涂成高速增感物质 ,两侧涂成中速增感物质。结果　用新屏对 7例患者进行投照 ,其结果是脊柱、纵隔、心后肺内占位病灶均较清晰地显示在同一张照片上 ,基本达到预期目的。结论　在常规胸片上 ,新型宽域X线增感屏能给X线诊断提供更多、更清晰、层次更加丰富的影像信息     

Clinical utility of quantitative magnetic resonance angiography in the assessment of the underlying pathophysiology in a variety of cerebrovascular disorders

Background

Quantitative MRA (qMRA) is a relatively new technique that uses traditional time-of-flight and phase-contrast MRI to visualize extracranial and intracranial vascular anatomy and measure volumetric blood flow. We aimed to assess the clinical utility of qMRA in assessing the hypothesized pathophysiology (HP) in a range of cerebrovascular diseases. Moreover, we postulated that evaluation of the arterial waveforms, can improve the evaluation of the hypothesized pathophysiology by qMRA.

Methods

We reviewed studies from 10 patients who underwent qMRA examinations before and after their treatments. Two reviewers assessed the anatomy, volumetric flow rates and arterial waveforms for each vessel sampled and reached a consensus as to whether the above parameters supported the clinical diagnosis/hypothesized pathophysiology and the subsequent management.

Findings

All 20 qMRA studies were technically adequate. qMRA supported the HP in all 10 patients as determined by abnormal volumetric flow values in the affected vessels before treatment and by the correction of these abnormal values in the patients whose treatment was successful. Each of our five patients with occlusive disease/vasoconstriction demonstrated evidence of dampening of the arterial waveforms distally to the narrowed artery (parvus–tardus phenomenon). The parvus–tardus effect disappeared after treatment.

Conclusion

qMRA is unique in combining time-of-flight MRA in a complementary manner with phase-contrast MRA to obtain volumetric flow values and potentially important physiologic information from arterial waveform analysis in patients with a range of cerebrovascular diseases during the course of a single MR examination.     

Error rates in proficiency testing in Australia

ABSTRACT

Recent criticism of forensic science has focused on the fundamental aspects of the science, including the lack of supporting empirical studies, validation, accreditation, limitations and error rates. Proficiency tests are an essential component of accreditation and can be used to evaluate laboratory performance and identify systematic issues within components of the service provision. In 2016 we reported on the results of an analysis of 3176 CTS proficiency tests undertaken between 2005 and 2015 by Australian government service providers. The data analysed represented 43 unique CTS test types and covered 21 disciplines. Here we present further data from 2016 to 2017 and compare these results with those obtained from the previous study. These combined results further demonstrate that errors exist even though practitioners know they are examining proficiency tests and the tests undergo a review process. This study illustrates the need to continue to monitor trends in proficiency test results and also further highlights the need for well-designed, relevant, blind error rate studies to determine the approximate error rates for casework.     

90株真菌检测及药敏试验

目的 了解我院真菌分离及耐药情况,为临床抗真菌治疗提供依据.方法 对本院2006年6～12月送检的标本进行真菌培养鉴定及药敏试验.结果 2006年下半年从临床各种送检标本中检出真菌90株,以白色念株菌检出率最高为61.1%,其次为热带念株菌28.9%;痰标本真菌分离例数最多53株;在各年龄段的真菌分布中,以71～80岁男性患者所占比例最大为26.7%;体外抗真菌药敏试验以两性霉素B敏感性最好,平均耐药率最低为3.3%.结论 真菌感染越来越多,加强真菌分离及药敏监测,合理用药,有助于患者的治疗.     

肝门部胆管癌治疗方法演变与预后

目的探讨肝门部胆管癌治疗方法的变化及效果。方法回顾分析1990年1月─2009年8月收治的198例肝门部胆管癌的临床特点、诊断、分期、治疗方式及随访结果。结果梗阻性黄疸仍为肝门部胆管癌的首发临床表现,肝门部CT及核磁胆道成像（MRCP）均为诊断的有效方法 ,阳性率高。肿瘤分期：2000年以前（A组）和2000年以后（B组）病例进行比较,BismuthⅠ期病例数较前增加不明显;BismuthⅡ、Ⅲ期为主要病例,且病例数有明显增加;BismuthⅣ期则相反,病例数有所减少,但无统计学意义（P〉0.05）。治疗中,49例患者采取非手术内外引流;手术的149例中,单纯引流24例,手术探查＋胆肠吻合51例,姑息性局部切除42例,胆管癌切除＋肝部分切除30例,肝移植2例。按照时间节点分析,A组61例手术中手术切除率为34.4%（21/61）,且以姑息性切除为主（16例）;B组88例手术中手术切除率为60.2%（53/88）,其中姑息性切除与根治性切除分别为26例和27例,两组比较有统计学意义（P〈0.05）。A组仅8例行局部放疗,B组中89例行局部聚焦放疗。从治疗效果分析,非手术内外引流及手术内外引流效果均不好,5年生存为个案。手术切除患者中,BismuthⅠ、Ⅱ期生存率最高,5年生存率83.3%（10/12）;BismuthⅢ期手术切除效果好于非手术治疗;BismuthⅣ期手术切除与否效果均不好,两组手术切除后的预后无统计学意义（P〉0.05）。手术结合术后放疗（γ刀）可在一定程度上延长患者生存时间。影响患者预后的主要因素为肿瘤复发转移,其中局部淋巴结转移与肝内广泛转移最为多见。结论肝门部胆管癌Ⅰ期的诊断并未因为CT和MRI应用而提高,中期BismuthⅡ、Ⅲ期较前例数有所增多,晚期患者相对下降。手术切除率较前有所提高,根治性与姑息性切除均有利于延长患者生存时间,手术切除结合局部放疗可在一定程度上延长患者生命。影响患者长期存活的主要原因仍旧是肿瘤的局部与肝内广泛转移,更加有效的治疗手段有待进一步研究。     

NMR relaxation rates and blood oxygenation level

A linear relationship between the proton relaxation rates and the fraction of deoxyhemoglobin of circulating whole blood (f_Hb) has been established in vitro at 4.7 T. These results have been interpreted on the basis of the additivity of relaxation rates. The slope of the lines of transverse relaxation rates (R₂) versus f_Hb was found to increase with interpulse delay in Carr-Purcell Meiboom-Gill (CPMG) experiments. The Luz-Mei-boom relation applied to this interpulse delay dependence of R₂ suggests a two-site chemical exchange rather than a diffusion mechanism. The 1-ms water proton exchange time derived from these observations has been interpreted in terms of exchange between exchangeable protons close to the paramagnetic center of hemoglobin and protons of bulk water.     

A multi-year injury epidemiology analysis of an elite national junior tennis program

Objectives

To profile multi-year injury incidence and severity trends in elite junior tennis players from a national program.

<Emphasis Type="Italic">Calliphora vicina</Emphasis> larvae grow at different rates on different body tissues.

Compared with the rate on pigs liver, larval growth of the blowfly, Calliphora vicina is significantly faster by as much as 2 days on lung, kidney, heart or brain tissue. Potentially this has major implications when laboratory growth rates of larvae fed on one food substrate (often liver) are used to calculate the amount of development, and therefore the postmortem interval in a forensic case.     

山西地区91株淋球菌耐药性分析

目的检测山西地区淋病奈瑟菌（NG）对5种抗生素的敏感性,分析其耐药特点。方法K—B琼脂扩散法测定NG对抗生素的敏感性及产色头孢噻吩法检测β-内酰胺酶。结果91株淋球菌对青霉素、四环素、环丙沙星、头孢曲松和大观霉素的耐药率分别为69．23％、87．91％、97．80％、0和5．49％,检出质粒介导的产青霉素酶的淋病奈瑟菌（PPNG）38株（41．76％）,同时耐2种及2种以上抗菌药物的多重耐药率为94．51％。结论青霉素、四环素及环丙沙星已不宜用于山西地区淋病的治疗;头孢曲松和大观霉素耐药率较低,可以作为山西地区治疗淋病的首选药物。但是大观霉素已出现耐药株．应引起重视。同时山西地区多重耐药现象十分严重。持续监测淋球菌的耐药性十分必要。