Villus packing density and lacunarity: Markers of placental efficiency?

We evaluate, in routine H&E histology slides, villus quantity in a given area (villous packing density, VPD) and the pattern or “gappiness” of villous distribution (lacunarity), and test for correlations with a proxy for fetoplacental metabolic rate, β calculated as (ln (placental weight)/ln (birthweight)) from Kleiber's law [1].Three ∼4.3 mm² images each were obtained from 88 term placentas. Ranges of VPD and lacunarity were each correlated with β (r = 0.31, p = 0.003, r = 0.23, p = 0.03 and respectively). The relationship between β and within-placenta variation in VPD and lacunarity highlights the need to study not merely the mean but the variance of villous geometries and spatial distributions.     

PW鞘辅助钬激光输尿管镜在男性尿道狭窄患者中的应用

目的 观察PW鞘辅助钬激光输尿管镜在男性尿道狭窄患者中的应用效果.方法 选择我院泌尿外科2011年5月至2014年5月收治的86例尿道狭窄男性患者,采用数表法随机分为对照组和观察组,每组43例,对照组应用钬激光输尿管镜治疗,观察组则采用PW鞘辅助钬激光输尿管镜治疗,比较两组患者治疗相关指标、治疗效果、并发症,以及复发和再手术情况.结果 两组患者手术均获得成功,成功率均为100%;观察组患者的平均手术时间较对照组短,术后平均尿道扩张次数较对照组少,差异均有统计学意义(P<0.05);观察组患者最大尿流率由治疗前的(8.3±2.1)mL/s提高到(17.2±3.9)mL/s,对照组由(8.5±2.8)mL/s提高到(14.3±3.4)mL/s,组内比较差异有统计学意义(P<0.05),而观察组患者治疗后最大尿流率大于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为4.65%,明显少于对照组的25.58%,差异有统计学意义(P<0.05).所有患者均随访至2016年5月,观察组复发率和再手术率分别为20.93%和9.30%,均明显低于对照组的44.19%和27.91%,差异均有统计学意义(P<0.05).结论 PW鞘辅助钬激光输尿管镜可提高术中视野清晰度,使组织分辨更加容易,对提高男性尿道狭窄患者手术疗效和安全性具有显著的作用.     

Impact of left atrial volume in prediction of outcome after cardiac resynchronization therapy

Left atrial volume index (LAVI) as a predictor of mortality has not been well investigated in patients with cardiac resynchronization therapy (CRT). The purpose of this study is to evaluate the impact of LAVI in predicting mortality in CRT patients.

Methods

We studied 100 consecutive patients who received CRT (male 73, age 69.9 ± 9.6 years). The follow-up duration of all echocardiographic measurements was 14.4 ± 10.5 months after CRT. LAVI was measured from apical views on two-dimensional echocardiography by bi-plane rule. A decrease of left ventricular end systolic volume ≥ 15% after CRT was defined as a positive response to CRT.

Results

The mean LAVI at baseline was 59.9 ± 22.7 ml/m². LAVI in patients who died (78.2 ± 27.5 ml/m²) was significantly greater than those who survived (55.9 ± 19.5 ml/m², p < 0.0001) during follow-up of 17 ± 10.6 months. The area under ROC curve (AUC) for LAVI predicting death was 0.77 (p = 0.0001). The cutoff point for LAVI predicting death was LAVI > 59.4 ml/m². LAVI > 59.4 ml/m² was related to mortality by Cox proportional univariate regression [hazard ratio (HR) = 5.15, 95% CI = 1.48-17.93, p = 0.01]. After adjustment for the variables with significant difference by univariate regression, LAVI > 59.4 ml/m² was continuously related to mortality by multivariate regression (HR = 4.56, 95% CI, 1.30-15.97, p = 0.02). LAVI > 59.4 ml/m² was associated with a near 5-fold increase in mortality during follow-up of 17 ± 10.6 months.

Conclusion

Patients who have LAVI > 59.4 ml/m² continue to have increased mortality despite CRT.     

Vascular angiotensin receptors and their role in blood pressure control.

The renin angiotensin system has an important role in regulating arterial blood pressure in homeostasis and disease. A reciprocal relationship exists between sodium balance and the circulating levels of renin and angiotensin II. The vascular responsiveness to angiotensin II, the major vasconstrictor component of the renal pressor system, can be impaired by numerous factors including sodium depletion or a reduction in effective plasma volume. In situations in which the renin-angiotensin system is activated, a negative relationship between the angiotensin II pressor response and the circulating angiotensin II level is observed. This effect seems to involve a change of the angiotensin II receptor interaction in the vascular smooth muscle. The prevention of angiotensin II generation by the inhibition of converting enzyme causes an immediate increase in the pressor response to angiotensin; after bilateral nephrectomy, it takes much longer to develop. In addition, the depressor response to angiotensin antagnoists and converting enzyme inhibitor is preserved after bilateral nephrectomy for much longer periods than can be accounted for by the disappearance of circulating renin. These observations support the view that the decrease in vascular response to angiotensin II during sodium deprivation or when body fluid volumes are reduced is the result of prior occupancy of the receptor sites by endogenous hormone generated both in the plasma and locally within blood vessel walls. Therefore, a change in the number or affinity of receptors consequent to a change in sodium balance or as a modulating function of the renin-angiotensin system need not be postulated to explain changes in angiotensin vascular responsiveness.     

超声鉴别颈部淋巴结肿大性质的应用价值

目的 :探讨超声波对鉴别颈部淋巴结性质的意义。方法 :应用超声二维声像图、能量多谱勒血流图(CDPI)、脉冲多谱勒 (PW )图象分析 113个颈部淋巴结的动脉血流速度 (PSV)与阻力指数 (RI) ,并观察淋巴结内的血流形态。结果 :10 2个淋巴结所分的 3组间的二维声像图 ,淋巴结的血流特点及动脉血流PSV、RI有着显著的差异性。结论 :CDPI、PW与二维超声结合 ,参考临床症状对鉴别淋巴结性质有重要的作用     

Epidemiology of multiresistant Enterococcus avium isolates in a Greek tertiary care hospital

A retrospective survey of the isolation rate of Enterococcus avium during the period March 1994-February 2000 conducted in Laikon General Hospital using the WHONET software, revealed a peak in the isolation rates of this species during March 1995-February 1996. The ten strains isolated during this time were studied further. No glycopeptide resistance was detected but resistance to ampicillin, ciprofloxacin, erythromycin, gentamicin (high-level) and streptomycin (high-level) was present in nine, ten, nine, three and seven of the isolates, respectively. The genes aac(6')-Ie+aph(2")-Ia and ant(6)-I, encoding for high-level gentamicin and streptomycin resistance, respectively, were detected only in the isolates with the corresponding phenotypes. Beta-lactamase production and haemolysis were not detected. There was evidence of ward-, floor- and building-specific distribution among the different aminoglycoside resistance phenotypes. DNA fingerprinting by PFGE grouped six of the ten isolates in a single cluster with 83% similarity, even though they expressed various resistance phenotypes. These results suggest dissemination of resistance genes among both genetically related and unrelated strains.