Bronchoscopy in Japan: A survey by the Japan Society for Respiratory Endoscopy in 2006

Background and objective: In order to obtain information on the clinical application of bronchoscopy in Japan, the Japan Society for Respiratory Endoscopy (JSRE) conducted a postal survey. Methods: A questionnaire was sent to 526 authorized institutes of the JSRE. The subject was bronchoscopy procedures performed during 2006. Results: The response rate was 71.3%. The total number of bronchoscopies performed was 74 770. Of these, 74 412 were flexible bronchoscopies and 358 were rigid bronchoscopies. At least one JSRE‐authorized specialist had worked with 97% of respondents. Eighty‐five per cent of respondents performed bronchoscopy under topical anaesthesia for almost all patients. Seventy‐five per cent of respondents routinely used the oral route. The reported numbers of diagnostic bronchoscopies was 12 509 for simple bronchoscopy, 25 971 for forceps biopsy, 26 289 for brush biopsy, 25 659 for bronchial washing, 1387 for transbronchial needle aspiration and 6716 for BAL. Three deaths were caused by forceps biopsy (0.012%). The morbidity rates for these diagnostic procedures ranged from 0.14% to 2.5%. The reported numbers of therapeutic bronchoscopies was 476 for tracheobronchial stent, 164 for neodymium (Nd): yttrium‐aluminium garnet (YAG) laser photoresection (LPR), 40 for photodynamic therapy, 81 for balloon dilatation, 145 for endobronchial electrocautery, 120 for argon plasma coagulation, 109 for microwave coagulation (MWC), 116 for ethanol injection, 110 for foreign body removal and 89 for bronchial occlusion. Deaths occurred only as a consequence of Nd : YAG LPR (0.61%). The morbidity rates for these therapeutic procedures ranged from 0% to 5%. Conclusions: The preparation for, and practice of, bronchoscopy varied greatly between respondents. Diagnostic bronchoscopy was well tolerated and safe. Therapeutic procedures did not appear to be practised widely or frequently.     

Ethnicity and sex are strong determinants of diabetes in an urban Western society: implications for prevention

Aims/hypothesis This study was conducted to investigate the prevalence of diabetes and its association with ethnicity and sex, to identify subgroups at special risk.Methods We performed a population-based cross-sectional survey of 30- to 67-year-olds in an area of Oslo with low socio-economic status, and collected data using questionnaires, physical examinations and serum analyses for the 2,513 participants (attendance rate 49.3%).Results In the age group 30–59 years, mean BMI was 28.5 (95% CI: 27.5–29.6) for South Asian women, 26.1 (25.9–26.4) for Western women, 26.7 (26.1–27.4) for South Asian men and 27.2 (26.9–27.5) for Western men. The diabetes prevalence rates were 27.5% (18.1–36.9) for South Asian women, 2.9% (1.9–3.4) for Western women, 14.3% (8.0–20.7) for South Asian men and 5.9% (4.2–7.5) for Western men. The age-adjusted odds ratio (OR) for diabetes for women vs men was 1.9 (0.9–4.1) for South Asians, and 0.4 (0.3–0.6) for the Western population (p<0.001). The age-adjusted OR for diabetes for South Asians vs Westerners was 11.0 (5.8–21.1) for women and 3.0 (1.6–5.4) for men, and after adjustment for WHR the ORs were 7.7 (3.9–15.3) for women and 2.6 (1.4–4.9) for men. After additional adjustments for physical activity, education, body height and fertility for women, the OR was 6.0 (2.3–15.4) for women and 1.9 (0.9–4.0) for men.Conclusions/interpretation The alarmingly high prevalence of diabetes among South Asian women in Norway needs further investigation, as it has considerable public health implications. Ethnic differences in OR for diabetes persisted after adjustment for age, adiposity, physical activity and education. These differences were still present for women after additional adjustment for body height and fertility.     

Delta5-androstenediol: kinetics of metabolism and binding to plasma proteins in normal men and women.

Using the constant fusion and single injection technique the metabolic clearance rates (mean +/- SEM) for delta5-androstene-3beta, 17beta-diol (delta5-idol) were measured for 19 normal men (1311 +/- 67 1/24 h) and 10 normal women (858 +/- 63 1/24 h). The constant infusion technique yielded values for the conversation ratios for the transformation of delta5-diol to several products: dehydroepiandrosterone (DHEA)/delta5-diol of 0.06+/-0.01 for men and 0.05 +/- 0.01 for women, of delta5-diol sulfate/delta5-diol of 0.45 +/- 0.04 for men and 0.52 +/- 0.03 for women and of DHEA sulfate/delta5-diol of 5.53 +/- 0.26 for men and 5.02 +/- 0.42 for women. The single injection technique yielded rate constants (units) and volumes of distribution (liters) for delta5-diol; Ki = 34.3 +/- 4.3 for men and 35.0 +/- 3.9 for women, K2 = 63.7 +/- 4.1 for men and 75.1 +/- 4.2 for women, V1 = 23.1 +/- 3.2 for men and 11.9 +/- 2.3 for women, V2 = 14.8 +/- 3.7 for men and 9.2 +/- 3.2 for women. The mean delta5-diol plasma concentration was 1.08 +/- 0.10 ng/ml for 12 men and 1.17 +/- 0.16 ng/ml for 9 women. (he calculated blood production rates for delta5-diol were 1357 +/- 117 mug/24 h for 12 men and 969 +/- 131 mug/24 h for 9 women. The per cent binding (equilibrium dialysis) was higher for women (94.9 +/- 0.3) than for men (93.0 +/- 0.2). Paper electrophoresis showed that significant fractions of 3H-delta5-diol migrated with both the beta-globulin and albumin fractions. Estrogen administration to two normal men increased the per cent binding of delta5-diol to plasma proteins and decreased the metabolic clearance rate towards the values found for normal women.     

Acute pyelonephritis in adults: prediction of mortality and failure of treatment

BACKGROUND: To formulate a classification tool for early recognition of patients admitted with acute pyelonephritis (AP) who are at high risk for failure of treatment or for death. METHODS: A retrospective chart review of 225 patients (102 men) admitted with AP. We considered 13 potential risk factors in a multivariate analysis. RESULTS: Recent hospitalization, previous use of antibiotics, and immunosuppression were found to be independent correlates of the prevalence of resistant pathogens in both sexes. Additional predictors included nephrolithiasis in women and a history of recurrent AP in men. Prolonged hospitalization should be expected for a man with diabetes and long-term catheterization who is older than 65 years or for a woman of any age with the same characteristics, when the initial treatment was changed according to the results of urine culture. For mortality prediction, we derived an integer-based scoring system with 6 points for shock, 4 for bedridden status, 4 for age greater than 65 years, and 3 for previous antibiotic treatment for men and 6 points for shock, 4 for bedridden status, 4 for age greater than 65 years, and 3 for immunosuppression for women. Among patients with at least 11 points, the risk for in-hospital death was 100% for men and 91% for women. CONCLUSIONS: Simple variables available at presentation can be used for risk stratification of patients with AP. The additional identification of certain risk factors by means of a carefully obtained history could contribute to early recognition of patients infected by resistant bacteria and optimize the selection of antimicrobial agents.     

Dehydroepiandrosterone: kinetics of metabolism in normal men and women.

The single injection and constant infusion techniques were utilized to study the kinetics of dehydroepiandrosterone (DHEA) metabolism and its peripheral conversion to several other C19-steroids including C19-steroid sulfates. The MCRs (mean +/- SEM) for normal men and normal women were 1866 +/- 144 and 1901 +/- 87 liters/24 h, respectively. The single injection technique yielded values for rate constants (units) and volumes of distribution (1) as follows: K1, 42.6 +/- 7.7 for men and 37.1 +/- 5.0 for women; K2, 64.3 +/- 11.2 for men and 55.5 +/- 5.0 for women; K2, 64.3 +/- 11.2 for men and 55.5 +/- 5.0 for women; V1, 38.5 +/- 6.0 for men and 33.7 +/- 2.5 for women; V2, 30.4 +/- 7.3 for men and 27.5 +/- 9.9 for women. The constant infusion technique yielded values for the conversion ratios for the transformation of DHEA to several products: delta 5-androstene-3 beta, 17 beta-diol to DHEA of 0.10 +/- 0.01 for men and 0.16 +/- 0.03 for women, delta 4-androstenedione to DHEA of 0.04 +/- 0.01 for men and 0.07 +/- 0.02 for women, DHEA sulfate (DHEAS) to DHEA of 6.36 +/- 0.81 for men and 10.09 +/- 0.87 for women, delta 5-androstene-3 beta, 17 beta-diol sulfate to DHEA of 0.42 +/- 0.06 for men and 0.50 +/- 0.04 for women, and androsterone sulfate to DHEA of 1.11 +/- 0.13 for men and 2.06 +/- 0.18 for women. The ratios for the conversion to DHEA sulfate and androsterone sulfate were significantly higher for women than men. The plasma concentrations of DHEA were 8.50 +/- 0.95 and 8.75 +/- 1.01 ng/ml for men and women, respectively. The calculated production rates for DHEA were 16.34 +/- 2.66 and 16.19 +/- 1.78 mg/24 h for men and women, respectively. There was no sex difference in the binding of DHEA to plasma proteins and this is reflected in the lack of sex difference in the MCRs. Calculations indicate that DHEA is a major precursor of circulating delta 5-diol.     

A comparative study of the follow-up and hemodynamics in vivo of 21 mm Carpentier-Edwards supra-annular and perimount bioprostheses

INTRODUCTION AND OBJECTIVES: Analysis and comparison of the clinical performance and hemodynamics in vivo of 21 mm Carpentier-Edwards supra-annular (CESA) and Perimount (CEPM) aortic bioprostheses. METHODS: A follow-up study was made of 40 patients implanted a 21 mm CESA (n = 21) or CEPM (n = 19) prosthesis between October 1992 and September 1997. All eligible survivors (14 CESA, 12 CEPM) were assessed echocardiographically. RESULTS: There were no significant differences between models in the effective orifice area (1.6 cm2 for CESA, 1.44 cm2 for CEPM), peak flow rate (rest: 2.5 m/s for CESA, 2.3 m/s for CEPM; post-dobutamine: 3.4 m/s for CESA, 3.3 m/s for CEPM), mean flow rate (rest: 1.7 m/s for CESA, 1.6 m/s for CEPM; post-dobutamine: 2.5 m/s for CESA, 2.2 m/s for CEPM), peak gradient (rest: 28.3 mmHg for CESA, 21.6 mmHg for CEPM; post-dobutamine: 48.4 mmHg for CESA, 41.6 mmHg for CEPM), and mean gradient (rest: 15.8 mmHg for CESA, 12.0 mmHg for CEPM; post-dobutamine: 28.5 mmHg for CESA, 22.5 mmHg for CEPM). CONCLUSION: In our experience, these two prosthetic models have similar hemodynamic characteristics in small aortic annuli.     

Laser treatment of rectosigmoidal tumors: long-term results]

Over a 10 year period, 530 patients were treated at the Lille Laser Center for a rectosigmoid tumour. Both argon and Nd:YAG lasers were used. Two hundred patients were treated for palliation of symptoms from a rectosigmoid cancer, 313 patients were treated for a rectosigmoid villous adenoma, and 17 patients with a familial polyposis were treated for the rectal polyposis remaining after total colectomy. The immediate success rate and complication rate were 88% and 2.7%, respectively, for patients with advanced cancer, 92% and 2% for those with a villous adenoma, and 100% and 0% for those with polyposis. Patients with an advanced cancer remained functionally improved during a 10.1 month average period after initial improvement. The recurrence rate after initial treatment for villous adenomas was 14% during a 3.1 year average follow-up. Immediate results were influenced by reason for treatment, initial symptoms and circumferential extension for patients with a cancer, and only by circumferential extension for patients with a villous adenoma. Long term results were influenced by reason for treatment and circumferential extension for patients with a cancer, and by reason for treatment, initial histology and localization for patients with a villous adenoma.     

Sialic Acid: New Potential Marker of Alcohol Abuse

BACKGROUND: A number of laboratory markers are suggested for the detection and monitoring of alcohol abuse. However, there is still a need to find better indicators of alcohol abuse. Sialic acid (SA) is the name for a series of acyl-derivatives of neuraminic acids that occur as nonreducing terminal residues of glycoproteins or glycolipids in biological fluids and cell membranes. In this study, we investigated the diagnostic value of SA as a marker of alcohol abuse. METHODS: Sera from social drinkers (n = 38) and alcoholics (n = 77) were analyzed for sialic acid by a colorimetric assay and for carbohydrate-deficient transferrin (CDT) by a radioimmunoassay method. Mean corpuscular volume (MCV), gamma-glutamyltransferase (GGT), aspartate aminotransferase (ASAT), and alanine aminotransferase (ALAT) were determined by using routine methods. RESULTS: The sialic acid levels of both female and male subjects were significantly (p < 0.001) increased among alcoholic subjects when compared with social drinkers. SA levels were decreased after 3 weeks of treatment. The sensitivity and specificity for SA, respectively, were 57.7 and 95.5 for women and 47.8 and 81.3 for men. The respective values for CDT were 57.7 and 95.5 for women and 78.3 and 100.0 for men; for GGT, 60.0 and 95.5 for women and 60.9 and 87.5 for men; for MCV, 52.4 and 95.5 for women and 47.8 and 100.0 for men; for ASAT, 53.8 and 95.5 for women and 43.5 and 100.0 for men; and for ALAT, 38.5 and 90.9 for women and 39.1 and 87.5 for men. Among women, SA and GGT, and among men CDT, showed the largest area under receiver operation curve. CONCLUSION: This study indicated that sialic acid levels were elevated by high alcohol consumption and reduced during abstinence, especially among women. Thus, sialic acid seems to be an interesting marker that needs further evaluation as a diagnostic tool for alcohol abuse.     

Oncology drug development: United States Food and Drug Administration perspective

The Food and Drug Administration (FDA) in the United States has multiple roles. The primary responsibilities for oncology drug products are the supervision of clinical research, the evaluation of marketing claims for new and previously approved drugs, the granting of exclusive marketing licenses for approved claims, and the monitoring of post-marketing activity for safety. Additional roles include providing incentives for developing products for rare diseases and children. The principles used for monitoring clinical studies are based on science, law and ethical guidelines. The principles used for evaluation of evidence to support marketing claims are based in science, law, regulation, and frequently the advice of a panel of external experts. Approved products should demonstrate patient benefit that is commensurate with the probable risks. The types of endpoints and their advantages and disadvantages for regulatory review are discussed. There are regulatory options available for conditional approval based on surrogate endpoints that are likely to predict patient benefit, a mechanism for reducing the time to review an application for indications with no known effective therapy, and procedures for providing access to patients for unapproved drugs.     

Trends in incidence rates of ulcerative colitis and Crohn's disease

Between 1960 and 1979, three studies were conducted in the Baltimore Standard Metropolitan Statistical Area to ascertain the incidence rates of first hospitalizations for ulcerative colitis and Crohn's disease. The age-adjusted rates per 100,000 population for the 1977-1979 survey for ulcerative colitis in white and nonwhite males and females were 2.92, 1.79, 1.29, and 2.90, respectively; the Crohn's disease rates were 3.39, 3.54, 1.29, and 4.08, respectively. In Baltimore the age-adjusted rate for Crohn's disease has increased to exceed the ulcerative colitis rate for whites of both sexes and nonwhite females. The ulcerative colitis and Crohn's disease rates for nonwhite males are similar. The rate for white males exceeds that for nonwhite males for both ulcerative colitis and Crohn's disease, but the converse is true for females. Females have higher rates than males for Crohn's disease in both color groups and for ulcerative colitis among nonwhites. White ulcerative colitis rates are higher for males than for females. From the first to the second surveys, the white male and female rates for ulcerative colitis converge with increasing male and decreasing female rates, but then both decline from the second to the third surveys. For Crohn's disease, the age-adjusted rates increased for whites of both sexes and nonwhite females from the first to second surveys. The Crohn's disease rates appeared to stabilize for whites of both sexes between the second and present surveys, but they increased for nonwhites of both sexes. Trends in age-adjusted rates for other areas are also discussed.     

Patient stratification in the management of acute bacterial exacerbation of chronic bronchitis: the role of levofloxacin 750 mg.

This is the first prospective clinical trial in which patients with acute bacterial exacerbation of chronic bronchitis have been stratified by degree of underlying illness. Uncomplicated patients were randomised to levofloxacin 750 mg once daily (q.d.) for 3 days or azithromycin q.d. for 5 days. Complicated patients were randomised to levofloxacin 750 mg q.d. for 5 days or amoxicillin 875 mg/clavulanate 125 mg twice daily for 10 days. Regardless of therapy, complicated patients demonstrated lower clinical and microbiological success than uncomplicated patients. Clinical success for clinically evaluable patients was similar for levofloxacin and azithromycin (93.0 versus 90.1%, respectively), and levofloxacin and amoxicillin/clavulanate (79.2 versus 81.7%, respectively). For microbiologically evaluable patients, clinical response to levofloxacin for 3 days was superior to azithromycin for 5 days (96.3 versus 87.4%, respectively), and levofloxacin for 5 days was similar to amoxicillin/clavulanate for 10 days (81.4 versus 80.9%, respectively). Microbiological eradication was superior for levofloxacin for 3 days compared with azithromycin for 5 days (93.8 versus 82.8%, respectively), and similar for levofloxacin and amoxicillin/clavulanate for 10 days (81.4 versus 79.8%, respectively). In conclusion, levofloxacin 750 mg for 3 days was comparable to azithromycin for 5 days for uncomplicated patients with acute bacterial exacerbation of chronic bronchitis, while 5 days of 750 mg levofloxacin was comparable to 10 days of amoxicillin/clavulanate for complicated acute bacterial exacerbation of chronic bronchitis.     

Validity of ultrasonography and measures of adult shoulder function and reliability of ultrasonography in detecting shoulder synovitis in patients with rheumatoid arthritis using magnetic resonance imaging as a gold standard

Objective

To assess the intra‐ and interobserver reproducibility of musculoskeletal ultrasonography (US) in detecting inflammatory shoulder changes in patients with rheumatoid arthritis, and to determine the agreement between US and the Shoulder Pain and Disability Index (SPADI) and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, using magnetic resonance imaging (MRI) as a gold standard.

Methods

Eleven rheumatologists investigated 10 patients in 2 rounds independently and blindly of each other by US. US results were compared with shoulder function tests and MRI.

Results

The positive and negative predictive values (NPVs) for axillary recess synovitis (ARS) were 0.88 and 0.43, respectively, for posterior recess synovitis (PRS) were 0.36 and 0.97, respectively, for subacromial/subdeltoid bursitis (SASB) were 0.85 and 0.28, respectively, and the NPV for biceps tenosynovitis (BT) was 1.00. The intraobserver kappa was 0.62 for ARS, 0.59 for PRS, 0.51 for BT, and 0.70 for SASB. The intraobserver kappa for power Doppler US (PDUS) signal was 0.91 for PRS, 0.77 for ARS, 0.94 for SASB, and 0.53 for BT. The interobserver maximum kappa was 0.46 for BT, 0.95 for ARS, 0.52 for PRS, and 0.61 for SASB. The interobserver reliability of PDUS was 1.0 for PRS, 0.1 for ARS, 0.5 for BT, and 1.0 for SASB. P values for the SPADI and DASH versus cuff tear on US were 0.02 and 0.01, respectively; all other relationships were not significant.

Conclusion

Overall agreements between gray‐scale US and MRI regarding synovitis of the shoulder varied considerably, but excellent results were seen for PDUS. Measures of shoulder function have a poor relationship with US and MRI. Improved standardization of US scanning technique could further reliability of shoulder US.     

Anaplasma phagocytophilum infection in domestic animals in ten provinces/cities of China

A nationwide epidemiologic investigation of domestic animal infections has been conducted in nine provinces and one city during 2007-2010. Serum samples from a total of 707 goats, 433 cattle, and 219 dogs were collected for detecting Anaplasma phagocytophilum IgG antibody by immunofluorescence assays and the average seroprevalences were 10.05% for dogs, 3.82% for goats, and 0.69% for cattle, respectively. A total of 472 goats, 201 cattle, 102 dog blood clots, and 1,580 ticks were collected for polymerase chain reaction (PCR) amplifying A. phagocytophilum 16S rRNA genes and the PCR-positive rates were 26.69% for goats, 23.38% for cattle, and 10.89% for dogs. Six species were identified and the average PCR-positive rates were 58.3% for Dermacentor silvarum, 43.9% for Haemaphysalis longicornis, 12.5% for Ixodes persulcatus, 7.5% (3 of 40) for Boophilus microplus, and 5.2% for Rhipicephalus sanguineus, respectively. The evidence in the study indicated the zoonotic Rickettsia is highly prevalent in China.     

Is it appropriate to routinely use a nucleic acid amplification test for the diagnosis of tuberculosis?

The purpose of this study was to compare the usefulness of the nucleic acid amplification (NAA) test against conventional tests under normal laboratory operational conditions. The NAA test was performed on the first sputum specimen of all patients. Liquid media culture, solid media culture, and Ziehl-Neelsen stain for an acid-fast bacilli (AFB) smear were performed on three sputum specimens. The results were calculated using the gold standard of either the culture results or the clinical diagnosis. Of the 593 patients tested, 151 (25.5%) were diagnosed with pulmonary tuberculosis. The sensitivity of the first specimen only was 64% for the NAA test, 54% for the AFB smear, 77% for BACTEC MGIT 960 culture, 40% for Lowestain-Jensen (LJ) culture, and 25% for 7H11 culture. The sensitivity when using all three specimens increased to 63% for AFB smear, 87% for BACTEC MGIT 960 culture, 51% for LJ culture, and 40% for 7H11 culture. The specificity was 100% for all culture tests, 99% for the AFB smear, and 99.5% for NAA test. The mean turnaround time was 1.34 days for NAA, 0.59 days for AFB smear, 11 days for BACTEC MGIT 960 culture, 23 days for LJ culture, and 20 days for 7H11 culture. We conclude that the sensitivity of NAA is still far from ideal, and the test is not cost effective. Thus, the COBAS AMPLICOR PCR system is not suitable for routine use in microbiology laboratories.     

Prenatal diagnosis of hematologic diseases, 1986 update

Prenatal diagnosis has been performed in more than 11,000 fetuses at risk for hematologic diseases. This paper summarizes the data from 30 centers from 1974 to 1985: 70% had fetal blood taken for hemoglobinopathies, of which 93% were for thalassemia and 7% for sickle disorders; 13% had DNA analyses for hemoglobinopathies, 54% for thalassemia and 46% for sickle disorders; 17% were investigated for other hematologic diseases using fetal blood, while 0.1% of the cases were studied for other diseases by DNA techniques. Error rates for all types of studies were under 1%, and fetal losses below 4%. Approximately 95% of families received safe, accurate information.     

A study of hepatic low Km iodothyronine 5'-monodeiodinase

To document the presence of a low Km rT3 and T4-5'-monodeiodinase (5'MDL; Km in nanomolar concentrations) in the liver and to study its characteristics in comparison with the high Km 5'MD (5'MDH; Km in micromolar concentrations), we incubated rat liver microsomal protein (20 micrograms for rT3 substrate and 200 micrograms for T4 substrate) with 125I-labeled rT3 or T4 and dithiothreitol (DTT; up to 20 mM) for 5 min (for rT3) or 30-120 min (for T4) and determined the amount of 125I liberated during incubation. Pilot studies had shown that the activity of rT3 5'MDH is markedly (greater than or equal to 85%) inhibited in the presence of 2 M NaCl, while the rT3 5'MDL is essentially unaffected, and both low and high Km T4 5'MD are minimally (approximately 20%) inhibited. The representative kinetics of various substrates studied were: Km, 13 nM for rT3 5'MDL, 640 for rT3 5'MDH, 26 for T4 5'MDL, and 3620 for T4 5'MDH; maximum velocity, 0.28 nmol/h.mg protein for rT3 5'MDL, 46 for rT3 5'MDH, 0.002 for T4 5'MDL, and 0.46 for T4 5'MDH. Propylthiouracil and iopanoate inhibited all enzymic activities studied. The relative Ki values (micromolar concentrations) for propylthiouracil were: 7.1 for rT3 5'MDL, 1.5 for rT3 5'MDH, 24 for T4 5'MDL, and 40 for T4 5'MDH; those for iopanoate were 0.4 for rT3 5'MDL, 18 for rT3 5'MDH, 7.0 for T4 5'MDL, and 4.0 for T4 5'MDH. DTT was a potent stimulator of enzyme activities studied; its dose (millimolar concentrations) that caused a 50% maximal stimulation was 0.04 for rT3 5'MDL, 1.0 for rT3 5'MDH, 0.025 for T4 5'MDL, and 0.035 for T4 5'MDH. T4 inhibited rT3 5'-monodeiodination and vice versa. The Ki of T4 was 1.3 microM for rT3 5'MDL and 2.0 for rT3 5'MDH, while that of rT3 was 0.4 for T4 5'MDL and 0.6 for T4 5'MDH. We examined the activity of the hepatic 5'MDL (rT3, 0.5 nM; DTT, 0.06 nM; 2 M NaCl) and 5'MDH (rT3, 0.5 microM; DTT, 20 mM; no NaCl) in groups (six animals per group) of rats that were saline treated (control), thyroidectomized, or hyperthyroid (given T3, 20 micrograms/day for 5 days). The relative values for 5'MDL were (mean +/- SD) 17 +/- 3.0, 4.0 +/- 2.0 (P less than 0.01), and 24 +/- 2.0 (P less than 0.01) pmol/h.mg protein, respectively, whereas those for 5'MDH were 13 +/- 4.0, 3.0 +/- 1.6 (P less than 0.01), and 25 +/- 1.0 (P less than 0.01) nmol/h.mg protein, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)     

肝癌消融技术管理与多元化的肝癌消融治疗团队的构建

消融是肝癌治疗的重要手段之一。规范的消融技术、科学合理的治疗策略以及密切的团队合作是取得良好疗效的重要前提。尽管近年来肝癌消融治疗的效果随着消融技术的不断改进而逐渐提高,但肿瘤复发率仍较高,因此亟需能更好地提高肝癌消融治疗的效果和改善患者预后的治疗策略。多元化的肝癌消融治疗团队的构建是根据肝癌消融治疗的需求,在常规肝癌消融治疗团队的基础上提出的新概念。由于多元化的肝癌消融治疗团队较常规肝癌消融治疗团队具有更多的潜在优势,因此其是一个具有潜力的消融团队构建的新模式。     

Risk factors for incomplete resection and complications in endoscopic mucosal resection for lateral spreading tumors

Aim: Lateral spreading tumors (LST) are relatively large flat lesions with diameters exceeding 10 mm in length. Endoscopic mucosal resection (EMR) is a commonly used technique for removing LST. We aimed to evaluate the risk factors for incomplete resection and complications of EMR for LST. Method: Between January 2004 and December 2010, 497 patients who underwent EMR for LST were retrospectively reviewed. Risk factors for endoscopic and histopathological complete resection, complications, and clinical outcomes were investigated. Results: Risks for incomplete resection by piecemeal resection and en bloc resection of a lesion ≥30 mm were higher than for en bloc resection of a lesion <30 mm (OR = 2.688, CI 1.036–6.993; OR = 4.982, CI 1.894–13.101). Risks of post‐EMR bleeding for piecemeal resection and en bloc resection for a lesion ≥40 mm were higher than for en bloc resection of a lesion < 40 mm (OR = 15.231, CI 1.816–127.744; OR = 43.043, CI 4.306–430.314). Conclusion: We found risk factors of EMR for LST and tentatively suggest a protocol for EMR adapted to the size of LST and resection methods. (i) Following piecemeal resection and en bloc resection for LST ≥ 40 mm, hospitalize patients for 36 h and note risk for incomplete resection and delayed bleeding. (ii) After en bloc resection for 40 mm > LST ≥ 30 mm, hospitalize patients for 12 h and note risk for incomplete resection. (iii) Following en bloc resection for LST < 30 mm, hospitalize the patient for 12 h and expect complete resection.     

Intrinsic lidocaine affinity for Na channels expressed in Xenopus oocytes depends on alpha (hH1 vs. rSkM1) and beta 1 subunits.

OBJECTIVE: The affinity of lidocaine for the alpha-subunit of the Na channel has been reported to be greater for heart than for non-heart alpha-subunits, and also to be no different. Lidocaine block has a complex voltage dependence caused by a higher affinity for the inactivated state over the resting state. Inactivation kinetics, however, depend upon the alpha-subunit isoform and the presence of the auxiliary beta 1-subunit and will affect measures of block. METHODS: We studied the voltage dependence of lidocaine block of Na currents by a two microelectrode voltage clamp in oocytes injected with RNA for the Na channel alpha-subunits of human heart (hH1a) or a rat skeletal muscle (rSkM1) alone, or coexpressed with the beta 1-subunit. RESULTS: The midpoints of availability for a 25-s conditioning potential in control solutions were -65 mV for rSkM1, -50 for rSkM1 + beta 1, -78 mV for hH1a and -76 for hH1a + beta 1. The Kd of tonic lidocaine block was measured at -90, -100, -110, -120 and -130 mV in the same oocytes. The apparent Kd for both isoforms +/- beta 1 became greater with more negative holding potentials, but tended to reach different plateaus at -130 mV (Kd = 2128 microM for rSkM1, 1760 microM for rSkM1 + beta 1, 433 for hH1a, and 887 microM for hH1a + beta 1). Inactivated state affinities, assessed by fitting the shift in the Boltzmann midpoint of the availability relationship to the modulated receptor model, were 4 microM for rSkM1, 1 microM for rSkM1 + beta 1, 7 microM for hH1a and 9 microM for hH1a + beta 1. CONCLUSION: The heart Na channel alpha-subunits expressed in oocytes have an intrinsically higher rest state affinity for lidocaine compared to rSkM1 after the voltage- and state dependence of block are considered. Coexpression with beta 1 modestly increased the rest affinity of lidocaine for rSkM1, but had the opposite effect for hH1a.     

A comparison of enzyme activity for energy production in the myocardium and conduction system.

Specific activities of enzymes in bovine hearts were measured. The enzyme activity ratios between the conduction system and the myocardium were 1.9 for G-6-PDH, 1.2 for PFK, 0.5 for total phosphorylase and LDH, 0.4 for GOT and MDH, 0.3 for SDH, 0.2 for Aldolase and CPK, and 0.1 for alpha GPDH. Approximate values for relative volume of Purkinje cells, nerve fibers and connective tissues in the conduction system were 30%, 8%, and 62%, respectively. It is concluded that activities of enzymes serving for anaerobic glycolysis in Purkinje cells are almost the same or slightly higher than those in the myocardium, and activity of enzyme for pentose shunt in the conductive tissue is higher than that in the myocardium.