三因素三水平呼吸参数在腹腔镜手术全麻中的选用

目的探讨腹腔镜手术CO2气腹(高腹压12mmHg)状态下全麻控制呼吸中,较低气道压力同时又能维持良好通气的呼吸参数的最佳组合。方法取麻醉机上最基本的呼吸频率(f)、潮气量(VT)、吸呼比(I∶E)三参数作为三因素A、B、C,f=15、12、9(次/min),VT=8、10、12(ml/kg),I∶E=1∶2.5、1∶2.0、1∶1.5为相应的三水平;以L9(34)K=3重复正交实验设计及分析用表统计、检验、分析各因素及水平变化影响气道峰压(peak inspiratory pressure,PIP)、气道平均压(Pmean)、呼气末二氧化碳分压(PETCO2)的统计学意义。结果9组试验27例腹腔镜手术全麻中,生命体征平稳,SpO2100%。PEEP监测值整个手术麻醉过程中始终为1hPa。三因素三水平呼吸参数的不同组合:①潮气量(B因素三水平)的不同对PIP的影响无统计学意义(P=0.074);②呼吸频率(A因素三水平)的改变对PETCO2有显著影响(P=0.002);③吸呼比(C因素三水平)的不同对气道平均压(Pmean)有较显著的统计学的意义(P=0.017)。结论多呼吸参数的最佳组合方式是A2B2C2:f...     

Applicability of IG/TCR gene rearrangements as targets for minimal residual disease assessment in a population‐based cohort of Swedish childhood acute lymphoblastic leukaemia diagnosed 2002–2006

Minimal residual disease (MRD) detection during the early treatment phase has become an important stratification parameter in many childhood acute lymphoblastic leukaemia (ALL) treatment protocols. Here, we aimed to address the applicability of rearranged antigen‐receptor genes as potential MRD markers using real‐time quantitative polymerase chain reaction (RQ‐PCR) in a Swedish population‐based cohort. From 334 childhood ALL cases diagnosed during 2002–2006, we analysed 279 diagnostic samples (84%) by screening for rearranged immunoglobulin (IG) and T‐cell receptor (TCR) genes. Allele‐specific oligonucleotides were designed, and the sensitivity and quantitative level was determined for each target. Overall, clonal IG/TCR rearrangements were detected in 97% (236/244) of B‐cell precursor ALL (BCP ALL) and 94% (33/35) of T‐ALL. A sensitive RQ‐PCR analysis (≤10^?4) was obtained in 89% (216/244) of BCP ALL and in 74% (26/35) of T‐ALL, whereas two sensitive targets were only available in 47% (115/244) of BCP ALL and 29% (10/35) of T‐ALL cases. With the stratification threshold of ≥10^?3, which is applied in the current Nordic treatment protocol (NOPHO‐ALL 2008) for the identification of high‐risk patients, 93% of BCP ALL and 86% of T‐ALL reached this quantitative range by at least one target gene. Taken together, this national retrospective study demonstrates that an IG/TCR target for MRD monitoring can be identified in the majority of childhood ALL cases, whereas identification of a second sensitive target gene needs to be improved.     

Quantitative grading of a human blastocyst: optimal inner cell mass size and shape

Objective: To investigate the predictive value of quantitative measurements of blastocyst morphology on subsequent implantation rates after transfer.

Design: Prospective observational study.

Setting: Private assisted reproductive technology center.

Patient(s): One hundred seventy-four IVF patients receiving transfers of expanded blastocyst-stage embryos on day 5 (n = 112) or day 6 (n = 62) after oocyte retrieval.

Intervention(s): None.

Main Outcome Measure(s): Blastocyst diameter, number of trophectoderm cells, inner cell mass (ICM) size, ICM shape, and implantation and pregnancy rates.

Result(s): Blastocyst diameter and trophectoderm cell numbers were unrelated to implantation rates. Day 5 expanded blastocysts with ICMs of >4,500 μm² implanted at a higher rate than did those with smaller ICMs (55% vs. 31%). Day 5 expanded blastocysts with slightly oval ICMs implanted at a higher rate (58%) compared with those with either rounder ICMs (7%) or more elongated ICMs (33%). Implantation rates were highest (71%) for embryos with both optimal ICM size and shape. Pregnancy rates were higher for day 5 transfers of optimally shaped ICMs compared with day 5 transfers of optimally sized ICMs.

Conclusion(s): Quantitative measurements of the inner cell mass are highly indicative of blastocyst implantation potential. Blastocysts with relatively large and/or slightly oval ICMs are more likely to implant than other blastocysts.     

A general framework for experiment design in diffusion MRI and its application in measuring direct tissue‐microstructure features

This article introduces a new and general framework for optimizing the experiment design for diffusion MRI of samples with unknown orientation. An illustration then uses the framework to study the feasibility of measuring direct features of brain‐tissue microstructure in vivo. The study investigates the accuracy and precision with which we can estimate potentially important new biomarkers such as axon density and radius in white matter. Simulation experiments use a simple model of white matter based on CHARMED (composite hindered and restricted model of diffusion). The optimization finds acquisition protocols achievable on modern human and animal systems that consist of 120 measurements with fixed maximum gradient strengths. Axon radii in brain tissue are typically in the range 0.25–10 μm. Simulations suggest that estimates of radii in the range 5–10 μm have highest precision and that a maximum gradient strength of 0.07 T m^?1 is sufficient to distinguish radii of 5, 10, and 20 μm. Smaller radii are more difficult to distinguish from one another but are identifiable as small. A maximum gradient strength of 0.2 T m^?1 distinguishes radii of 1 and 2 μm. The simulations also suggest that axon densities and diffusivity parameters in the normal range for white matter are recoverable. The experiment‐design optimization has applications well beyond the current work to optimize the protocol for fitting any model of the diffusion process. Magn Reson Med 60:439–448, 2008. © 2008 Wiley‐Liss, Inc.     

Effect of Hearing Aids on Psychosocial Dysfunctioning

The perception of communication abilities amongest adolescents with moderate and profound hearing loss was correlated with indices of psychosocial adjustment. This was done to determine whether the use of hearing aids could play a role in presence and improvement of psychosocial functioning among acquired hearing loss persons after the use of hearing aids. Amongest the deaf population, it was found that hearing loss did affect the social, the vocational, the personal and subjective well being, after intervention. The control group did not show any corresponding change except that the state anxiety among this group had increased.     

Investigating general practitioner engagement with pharmacists in Home Medicines Review

Abstract

The Home Medicines Review (HMR) involves a home visit from an accredited HMR pharmacist to review a patient’s medicines, and a report to the patient’s general practitioner (GP) with recommendations for improving medicine management. Notwithstanding evidence supporting the benefits of medicines review, broad uptake by GPs in Australia remains low. We developed the 10-item Home Medicines Review Inventory (HMRI) to assess GP attitudes and behaviours regarding the HMR and modelled factors associated with the frequency of GP engagement with HMRs. Four items assessing frequency of behaviours and six items assessing attitudes related to HMR were answered by 180 GPs in a national GP survey. The HMRI’s psychometric properties were examined with exploratory factor analysis (EFA), Rasch analysis, and correlations with related instruments. Structural equation modelling was used to evaluate factors associated with HMR-related behaviours. EFA and Rasch analysis generally supported the current format of the instrument. Attitudes to HMR, gender, previous positive experiences with pharmacists, a system for working together, and participation in joint education activities predicted frequency of HMR-related behaviours. Although GPs’ attitudes to HMR were generally positive, HMR-related behaviours tended to occur with low frequency. This instrument may be used to investigate why HMR uptake has thus far been low and also help identify opportunities for building interprofessional communication and trust between GPs and pharmacists.     

Chronic administration of dietary grape seed extract increases colonic expression of gut tight junction protein occludin and reduces fecal calprotectin: a secondary analysis of healthy Wistar Furth rats

Animal studies have demonstrated the potential of grape seed extract (GSE) to prevent metabolic syndrome, obesity, and type 2 diabetes. Recently, metabolic endotoxemia induced by bacterial endotoxins produced in the colon has emerged as a possible factor in the etiology of metabolic syndrome. Improving colonic barrier function may control endotoxemia by reducing endotoxin uptake. However, the impact of GSE on colonic barrier integrity and endotoxin uptake has not been evaluated. We performed a secondary analysis of samples collected from a chronic GSE feeding study with pharmacokinetic end points to examine potential modulation of biomarkers of colonic integrity and endotoxin uptake. We hypothesized that a secondary analysis would indicate that chronic GSE administration increases colonic expression of intestinal tight junction proteins and reduces circulating endotoxin levels, even in the absence of an obesity-promoting stimulus. Wistar Furth rats were administered drinking water containing 0.1% GSE for 21 days. Grape seed extract significantly increased the expression of gut junction protein occludin in the proximal colon and reduced fecal levels of the neutrophil protein calprotectin, compared with control. Grape seed extract did not significantly reduce serum or fecal endotoxin levels compared with control, although the variability in serum levels was widely increased by GSE. These data suggest that the improvement of gut barrier integrity and potential modulation of endotoxemia warrant investigation as a possible mechanism by which GSE prevents metabolic syndrome and associated diseases. Further investigation of this mechanism in high-fat feeding metabolic syndrome and obesity models is therefore justified.     

Effects of Several Doses of ~(60)Co Gamma Irradiation on Mouse Peritoneal Macrophages

Effects of several doses of~(60)Co gamma irradiation on mouse macrophages were in-vestigated by means of quantitative cytochemistry.It was found that the activities of lysosomalenzymes(acid phosphatase(AcPase)and a-naphthyl acetate esterose(ANAE)),adenosinetriphosphatase(ATPase)and positive substances of periodic acid Schiff's reaction(PAS)inperitoneal macrophages were increased after total-body irradiation (1,3Gy),and decreasedwith the increase of doses of total-body irradiation(5,8Gy).Meanwhile,the phagocytic ca-pacity and the size of peritoneal macrophages of irradiated mice also changed as compared withthe control group.