不同浓度罗哌卡因椎管内麻醉下外倒转术临床研究

正胎位异常与多种分娩期并发症有关,是造成难产的主要因素之一,臀位是最常见的异常胎位之一,占足月分娩的3%～4%~([1-4])。臀位分娩方式的选择需要充分评估母胎综合因素,选择阴道分娩还是剖宫产在当前医疗界仍存在较大争议。随着剖宫产、麻醉技     

CMR in Patients With Severe Myocarditis: Diagnostic Value of Quantitative Tissue Markers Including Extracellular Volume Imaging

ObjectivesThis study evaluated the accuracy of T2, T1, and extracellular volume (ECV) quantification as novel quantitative tissue markers in comparison with standard “Lake-Louise” cardiac magnetic resonance (CMR) criteria to diagnose myocarditis.BackgroundNovel approaches using T2 and T1 mapping may overcome the limitations of signal intensity-based parameters, which would potentially result in a better diagnostic accuracy compared with standard CMR techniques in suspected myocarditis.MethodsCMR was performed in 104 patients with myocarditis and 21 control subjects at 1.5-T. Patients with myocarditis underwent CMR 2 weeks (interquartile range: 1 to 7 weeks) after presentation with new-onset heart failure (n = 66) or acute chest pain (n = 38). T2 and T1 mapping were implemented into a standard protocol including T2-weighted (T2w), early gadolinium enhancement (EGE) CMR, and late gadolinium enhancement (LGE) CMR. T2 quantification was performed using a free-breathing, navigator-gated multiecho sequence. T1 quantification was performed using the modified Look-Locker inversion recovery sequence before and after administration of 0.075 mmol/kg gadobenate dimeglumine. T2, T1, and ECV maps were generated using a plug-in for the OsiriX software (Pixmeo, Bernex, Switzerland) to calculate mean global myocardial T2, T1, and ECV values.ResultsThe diagnostic accuracies of conventional CMR were 70% (95% confidence interval [CI]: 61% to 77%) for T2w CMR, 59% (95% CI: 56% to 73%) for EGE, and 67% (95% CI: 59% to 75%) for LGE. The diagnostic accuracies of mapping techniques were 63% (95% CI: 53% to 73%) for myocardial T2, 69% (95% CI: 60% to 76%) for native myocardial T1, and 76% (95% CI: 68% to 82%) for global myocardial ECV. The diagnostic accuracy of CMR was significantly improved to 90% (95% CI: 84% to 95%) by a stepwise approach, using the presence of LGE and myocardial ECV ≥27% as diagnostic criteria, compared with 79% (95% CI: 71% to 85%; p = 0.0043) for the Lake-Louise criteria.ConclusionsIn patients with clinical evidence for subacute, severe myocarditis, ECV quantification with LGE imaging significantly improved the diagnostic accuracy of CMR compared with standard Lake-Louise criteria.     

庄河市医疗机构设备配置及医疗环境现况调查

目的了解庄河市内各级医疗机构医疗器械配置现状,探究该市现行的医疗卫生政策、会诊中心、远程平台建设、使用及相关医保政策对本地医疗资源配置的原始作用,为该地区开展国产创新医疗设备的推广应用提供科学、合理的理论依据。方法采用"辽宁省创新诊疗设备区域应用示范项目"统一制定的访谈提纲与庄河市卫计局(包含医保部门)、二、三级医疗机构主管医疗设备配置、医疗卫生信息、会诊中心建设、医保政策等相关方面的相关领导进行面对面的交流、访谈。结果庄河市医疗器械配置上仍存在较大缺口,尤其是资金短缺的一级医疗机构;当地医保政策方面严格执行大连市制定标准,暂无其他政策引导支持;目前已完成了医联体及相关远程会诊中心的建设,但使用情况良莠不齐。结论就目前状况来看,庄河市医疗资源配置情况不容乐观,有必要加快推进"辽宁省创新诊疗设备区域应用示范项目"在本地区的实施,促进国产医疗设备向基层医院的投放,改善医疗环境,提升区域整体医疗服务能力和水平。     

辽宁省基层医疗机构服务能力评价相关设备配置和使用情况调查

目的了解辽宁省基层医疗机构与其功能定位相匹配的医疗设备配置和使用情况,为当地卫生健康行政部门管理调控基层医疗设备提供参考数据。方法调查对象包括辽宁省9个示范区/县辖区内所有社区卫生服务中心和乡镇卫生院。利用自编调查表,采用自填问卷形式对各医疗机构主管医疗设备的负责人进行问卷调查。结果34家社区卫生服务中心和81家乡镇卫生院纳入分析(86.5%)。除生化分析仪外,社区卫生服务中心和乡镇卫生院的各类相关设备配备数量水平相当,均处于较低水平,尤其DR、血液分析仪、尿液分析仪和血凝仪的配置率较低,27.8%的机构认为由于"设备数量不足"导致不能满足日常需求;38.4%的设备超过了折旧年限且乡镇卫生院占比更高(P=0.004),51.3%的机构认为由于"设备陈旧或水平不能满足需求"导致不能满足日常需求,客观指标与主观认知结果一致。此外,和社区卫生服务中心比较,更多的乡镇卫生院认为由于"技术人员水平不能满足诊疗需求"(33.8%vs.8.3%,P=0.006)和"缺乏操作人员"(47.3%vs.25.0%,P=0.042)导致设备使用不能满足日常需求,并存在更多的利用率低下的问题。两类基层医疗机构不能满足需求的前三位设备均为DR、超声和CT。结论辽宁省基层医疗机构设备配置和使用存在设备配置率和配置数量不足、设备陈旧、相关技术人员紧缺或技术水平有限、设备利用率低下等问题,且乡镇卫生院较社区卫生服务中心更为突出。当地卫生健康行政部门应针对上述问题进行有效的管理调控。     

Rewritable digital data storage in live cells via engineered control of recombination directionality

The use of synthetic biological systems in research, healthcare, and manufacturing often requires autonomous history-dependent behavior and therefore some form of engineered biological memory. For example, the study or reprogramming of aging, cancer, or development would benefit from genetically encoded counters capable of recording up to several hundred cell division or differentiation events. Although genetic material itself provides a natural data storage medium, tools that allow researchers to reliably and reversibly write information to DNA in vivo are lacking. Here, we demonstrate a rewriteable recombinase addressable data (RAD) module that reliably stores digital information within a chromosome. RAD modules use serine integrase and excisionase functions adapted from bacteriophage to invert and restore specific DNA sequences. Our core RAD memory element is capable of passive information storage in the absence of heterologous gene expression for over 100 cell divisions and can be switched repeatedly without performance degradation, as is required to support combinatorial data storage. We also demonstrate how programmed stochasticity in RAD system performance arising from bidirectional recombination can be achieved and tuned by varying the synthesis and degradation rates of recombinase proteins. The serine recombinase functions used here do not require cell-specific cofactors and should be useful in extending computing and control methods to the study and engineering of many biological systems.     

Cuantificación del área miocárdica en riesgo: validación de puntuaciones angiográficas coronarias con métodos de resonancia magnética cardiovascular

Introduction and objectives

Quantification of myocardial area-at-risk after acute myocardial infarction has major clinical implications and can be determined by cardiovascular magnetic resonance. The Bypass Angioplasty Revascularization Investigation Myocardial Jeopardy Index (BARI) and Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) angiographic scores have been widely used for rapid myocardial area-at-risk estimation but have not been directly validated. Our objective was to compare the myocardial area-at-risk estimated by BARI and APPROACH angiographic scores with those determined by cardiovascular magnetic resonance.

Methods

In a prospective study, cardiovascular magnetic resonance was performed in 70 patients with a first successfully-reperfused ST-segment elevation acute myocardial infarction in the first week after percutaneous coronary intervention. Myocardial area-at-risk was obtained both by analysis of T2-short tau inversion recovery sequences and calculation of infarct endocardial surface area with late enhancement sequences. These results were compared with those of BARI and APPROACH scores.

Results

BARI and APPROACH showed a statistically significant correlation with T2-short tau inversion recovery for myocardial area-at-risk estimation (BARI, intraclass correlation coefficient=0.72; P<.001; APPROACH, intraclass correlation coefficient=0.69; P<.001). Better correlations were observed for anterior acute myocardial infarction than for other locations (BARI, intraclass correlation coefficient=0.73 vs 0.63; APPROACH, intraclass correlation coefficient=0.68 vs 0.50). Infarct endocardial surface area showed a good correlation with both angiographic scores (BARI, intraclass correlation coefficient=0.72; P<.001; with APPROACH, intraclass correlation coefficient=0.70; P<.001).

Conclusions

BARI and APPROACH angiographic scores allow reliable estimation of myocardial area-at-risk in current clinical practice, particularly in anterior infarctions.Full English text available from:www.revespcardiol.org     

A modified I-PCR to detect the factor VIII Inv22 for genetic diagnosis and prenatal diagnosis in haemophilia A

To explore the effectiveness of modified inversion-polymerase chain reaction (I-PCR) to detect the factor VIII (FVIII) intron 22 inversion (Inv22) for genetic diagnosis and prenatal diagnosis in haemophilia A (HA). Both modified I-PCR and LD-PCR were applied to analyse the FVIII Inv22 for 24 patients with HA. Prenatal diagnosis was performed on six foetuses. Foetal blood samplings were carried out by cordocentesis from 22 to 26 weeks of gestation. Ten patients with FVIII Inv22 in 10 HA families were found, and the remaining 14 patients were found without the Inv22 in 19 HA families. Prenatal diagnosis confirmed that four foetuses were normal and all of them born normally. However, two foetuses had been identified as abnormal and undergone abortion. Compared with LD-PCR, modified I-PCR is more rapid and convenient for detecting the FVIII Inv22 in genetic diagnosis. It is recommended that a patient undergoes both modified I-PCR (to detect the FVIII Inv22) and biochemical assay (to measure the FVIII activity of umbilical cord blood) in prenatal diagnosis. When we have more experience, the DNA samples from chorionic villus or amniotic fluid can be analysed for prenatal diagnosis using the modified I-PCR alone.     

Representational demands modulate involvement of perirhinal cortex in face processing

The classic view holds that the medial temporal lobes (MTL) are dedicated to declarative memory functioning. Recent evidence, however, suggests that perirhinal cortex (PrC), a structure within the anterior MTL, may also play a role in perceptual discriminations when representations of complex conjunctions of features, or of gestalt‐characteristics of objects must be generated. Interestingly, neuroimaging and electrophysiological recordings in nonhuman primates have also revealed a face patch in the anterior collateral sulcus with preferential responses to face stimuli in various task contexts. In the present fMRI study, we investigated the representational demands that influence PrC involvement in different types of judgments on human faces. Holding stimulus complexity constant, we independently manipulated the nature of the task and the orientation of the stimuli presented (through face inversion). Aspects of right PrC showed increased responses in a forced‐choice recognition‐memory and a perceptual‐oddity task, as compared to a feature‐search task that was included to probe visual detection of an isolated face feature. Effects of stimulus orientation in right PrC were observed when the recognition‐memory condition for upright faces was compared with all other experimental conditions, including recognition‐memory for inverted faces‐a result that can be related to past work on the role of PrC in object unitization. Notably, both effects in right PrC paralleled activity patterns in broader networks of regions that also included the right fusiform gyrus and the amygdala, regions frequently implicated in face processing in prior research. As such, the current findings do not support the view that reference to a prior study episode clearly distinguishes the role of PrC from that of more posterior ventral visual pathway regions. They add to a growing body of evidence suggesting that the functional role of specific MTL structures may be best understood in terms of the representations that are required by the task and the stimuli at hand. © 2013 Wiley Periodicals, Inc.