The use of a bedside assay for plasma B-type natriuretic peptide as a biomarker in the management of patent ductus arteriosus in premature neonates

OBJECTIVE: To test the utility of the bedside plasma concentration of B-type natriuretic peptide (BNP) assay as a screen for patent ductus arteriosus (PDA) in premature neonates. STUDY DESIGN: Newborn infants admitted to the neonatal intensive care unit (NICU) had paired echocardiography and BNP measurements at enrollment and every 4 to 5 days. RESULTS: Twenty neonates (gestational age approximately 28.6 weeks and birth weight approximately 1161 g) had 81 paired echocardiography and BNP determinations. BNP ranged from 5 to 3900 pg/mL. Fifty-six of 81 echocardiograms showed PDA. Significant correlations were found between BNP and ductal size and degree of shunting. Correlation was greater in infants >2 days of age. BNP >300 pg/mL predicted significant PDA, whereas BNP <105 pg/mL predicted absence of significant PDA. CONCLUSION: Bedside measurement of BNP correlates with magnitude of PDA in premature newborns, particularly beyond day 2, and may be useful in guiding diagnostic and management strategies.     

Superior outcomes of microsurgical vasectomy reversal in men with the same female partners

OBJECTIVE: To evaluate the outcomes of vasectomy reversals in men with the same female partners. DESIGN: Retrospective analysis with comparison with a historical cohort. SETTING: University hospital. PATIENT(S): Among 1,048 patients who underwent microsurgical vasectomy reversal from 1986 to 2002, 27 men (2.6%) were identified who had the same partners as before their vasectomy. INTERVENTION(S): Microsurgical vasovasostomy or vasoepididymostomy. MAIN OUTCOME MEASURE(S): Semen parameters, clinical pregnancy, and live birth rates. RESULT(S): The mean age of the men was 38.5 years, and 37.2 years for their female partners. The reasons for vasectomy reversal were death of a child in 33% of cases and desire for more children in 66% of cases. The overall patency rate was 100% at 1 month postoperatively, with an average sperm concentration of 30 million/mL and 24% motility. Among patients with follow-up beyond 1 year, the natural pregnancy rate was 86%, which was achieved at 8.3 months postoperatively, with a live birth rate of 82%. The live birth rate in couples with the death of a child was 100%. CONCLUSION(S): The outcomes of vasectomy reversal in men with the same female partners are better than for men with new partners. Possible reasons for these superior results are previous proven fecundity as a couple, shorter time interval since vasectomy, and emotional dedication.     

Combined Effects of Multiple Flavonoids on Breast Cancer Resistance Protein (ABCG2)-Mediated Transport

PURPOSE: The purpose of this study was to determine the dynamic parameter (EC50) of flavonoids apigenin, biochanin A, chrysin, genistein, kaempferol, hesperetin, naringenin, and silymarin for breast cancer resistance protein (BCRP) inhibition when used alone, and to evaluate their potential interactions (additive, synergistic, or antagonistic) with regards to BCRP inhibition when used in multiple-flavonoid combinations. METHODS: The effects of flavonoids on BCRP-mediated transport were examined by evaluating their effects on mitoxantrone accumulation and cytotoxicity in MCF-7 MX100 cells overexpressing BCRP. The EC50 values of these flavonoids for increasing mitoxantrone accumulation were estimated using a Hill equation. The potential interactions among multiple flavonoids with regard to BCRP inhibition were assessed by isobologram and Berenbaum's interaction index methods. RESULTS: The EC50 values of these flavonoids for increasing mitoxantrone accumulation ranged from 0.39+/-0.13 microM to 33.7+/-2.78 microM. Quantitative analysis of the combined effects of multiple flavonoids on mitoxantrone accumulation indicated that these flavonoids act additively in inhibiting BCRP when given as 2-, 3-, 5-, or 8-flavonoid combinations with equimolar concentrations of all constituents. The results of the mitoxantrone cytotoxicity studies were consistent with these findings. CONCLUSIONS: The additive effects of multiple flavonoids for BCRP inhibition suggests that prediction of BCRP-mediated food (herbal product)-drug interactions should also take into consideration the presence of multiple flavonoids and provides a rationale for using "flavonoid cocktails" as a potential approach for multidrug resistance reversal in cancer treatment.     

IVF following impossible or failed surgical reversal of tubal sterilization

Microsurgical re-anastomosis or IVF offer ways of reversing previous tubal sterilization. This retrospective study analysed 56 attempts of IVF in 37 couples after impossible or failed surgical sterilization reversal. Efficacy of IVF in this group (TL) was compared with that of a tubal pathology control group (TP) at all stages of IVF (stimulation, fertilization and implantation). Depending on patient age, significantly fewer oocytes were produced after ovarian stimulation in the TL group than in the control (TP) group (P = 0.023 for all TL patients; P = 0.02 when patients aged >38 years were excluded). The total number of embryos available for transfer was significantly lower in the TL group (P = 0.0042), but this was age-related, since when women aged >38 years were excluded there was no significant difference between the two groups. The ongoing pregnancy rate was similar in both groups, the probability of ongoing pregnancy appearing to depend on patient age rather than on previous fertility.     

Current practice in the management of vasectomy reversal and unobstructive azoospermia in Merseyside & North Wales: a questionnaire-based survey

OBJECTIVE: To investigate the current incidence of vasectomy reversal procedures, the techniques used and which practitioners use them. PATIENTS AND METHODS: Using a questionnaire, 130 general surgeons and urologists practising in Merseyside and North Wales were surveyed. RESULTS: The response rate was 74%, with 24 urological surgeons and 14 general surgeons undertaking vasectomy reversal. Annually, urological surgeons carried out significantly more procedures than did general surgeons, at 8.5 and 5.3 (P = 0.029), respectively. They were also more likely to use double-layer closure and microsurgical techniques, whilst significantly less likely to use stents. Urologists reported significantly greater patency rates, at 76% and 52% (P = 0.017), respectively, with no significant differences in subsequent pregnancy rates (30% vs 25%). Only one practitioner checked tubal patency in the female partner before vasectomy reversal. CONCLUSIONS: The use of vasectomy reversal is a cost-effective treatment for men wanting paternity after vasectomy. The technique used by the clinician and proper audit of the results require close attention; it would also appear to be obvious that all the partners of men seeking a vasectomy reversal should have their fertility status established before reversal, something that is clearly not done at present.     

Visual evoked potentials in cerebral white matter hyperintensity on MRI

OBJECTIVES: To investigate the correlation of the cerebral white matter hyperintensities (WMH) on MRI, and latency and amplitude of visual evoked potentials (VEPs) in elderly subjects. PATIENTS AND METHODS: Pattern VEP (PVEP) and flash VEP (FVEP) were recorded in 25 patients with WMH consisting of 12 patients with frontal dominant WMH (FMH) and 13 patients with occipital dominant WMH (OMH) and 25 patients with basal ganglionic hyperintensities (BGH). RESULTS: In WMHs, there were significantly larger P100 and P2 amplitudes than in BGHs and controls. Regarding the distribution of WMH, OMH showed significantly larger P100 amplitudes than FMH. In OMH in males, there was significantly prolonged P100 latency compared with females, and in females, there were significantly larger P100 and P2 amplitudes compared with males. CONCLUSION: Appropriate clinical values in VEP should take into consideration WMH in addition to gender and age-related changes.     

输卵管绝育部位组织学及超微结构变化研究

目的:探讨影响输卵管绝育术后复通效果的相关因素。方法:绝育术后<5年、5-10年及>10年要求复通的绝育后妇女各20名,术中取双侧输卵管结扎近端和远端部位的组织,在光镜及电镜下比较组织学变化。结果:随着绝育时间的延长,输卵管黏膜受损越严重,光镜及电镜下黏膜上皮变化显著。结论:绝育时间越长,输卵管黏膜受损越严重,显微手术中充分切除病变组织,可明显提高手术成功率。     

腹腔镜输卵管吻合术:附32例临床分析

目的评价腹腔镜输卵管吻合术的输卵管通畅率及妊娠结局。方法对32位输卵管堵塞的患者行腹腔镜下显微输卵管吻合术并统计妊娠率（PR），以及影响妊娠结局的因素。结果32例中，术后通畅率为90.2%（55/61），术后宫内妊娠率为50.0%（16/32），无1例宫外孕发生。累积妊娠率，术后6个月为15.6%，12个月为43.8%，18个月为50.0%。96%的妊娠发生在术后一年内。峡部～峡部吻合妊娠率（55.0%）高于壶腹部～壶腹部妊娠率（41.7%）但无统计学差异。大于40岁患者妊娠率为（0/3），小于40岁患者妊娠率为55.2%（16/29）。结论腹腔镜输卵管吻合术具有较高成功率，是输卵管堵塞患者的一个较好的治疗选择。     

Reversal of Cardiac Cirrhosis Following Orthotopic Heart Transplantation

Irreversible hepatic cirrhosis greatly increases the risks attending heart transplantation (HT), and is accordingly considered to be an absolute contraindication for HT unless combined heart and liver transplantation can be performed. It is now recognized that hepatic cirrhosis can undergo regression if the source of insult is removed, but no cases of post-HT regression of cirrhosis of cardiac origin have hitherto been reported. Here we report a case of cardiac cirrhosis that underwent complete regression following orthotopic HT, and we discuss the implications of this case.