The anti-diabetogenic effect of essential fatty acid deficiency in multiple low-dose streptozotocin-treated mice persists if essential fatty acid repletion occurs outside of a brief window of susceptibility

Summary We have previously shown that essential fatty acid deficiency prevents diabetes mellitus and ameliorates insulitis in multiple low-dose streptozotocin-treated male CD-1 mice and that repletion with 99% pure methyl linoleate 3 days after the last injection causes diabetes. In the present study, we examined whether repletion of low-dose streptozotocin-treated deficient mice will cause diabetes whenever repletion occurs. Essential fatty acid deficiency was induced by dietary manipulation and was confirmed biochemically. Groups of deficient mice were repleted 6 h, 1 week, 2 weeks, 4 weeks and 8 weeks after the last low-dose streptozotocin treatment; the incidence of diabetes (i.e., non-fasting plasma glucose levels > 11.2 mmol/l) and group mean plasma glucose levels were 93% (19.4 mmol/l), 37% (14.8 mmol/l), 40% (13.7 mmol/l), 20% (9.0 mmol/l), and 8% (7.8 mmol/l) respectively. The incidence and mean glucose levels for low-dose streptozotocin-induced control chow-fed and non-repleted essential fatty acid deficient CD-1 mice were 100% (30.2 mmol/l) and 0% (4.2 mmol/l). The incidence and severity of insulitis also decreased with increasing repletion intervals. These results demonstrate a brief window of susceptibility of less than 8 weeks duration during which repletion will initiate an autoimmune response directed at low-dose streptozotocin-induced Beta-cell neoantigens in low-dose streptozotocin-treated essential fatty acid deficient mice.     

Low-dose dobutamine stress test for the evaluation of cardiac function using ultrafast computed tomography

High dose-dobutamine (DOB) has been previously used as a pharmacological stress test to evaluate wall motion abnormalities. As a result, recent stress echocardiography with low-dose DOB has been reported to be valuable for investigating stunned myocardium after thrombolysis. However, echocardiography requires an operator's skill and experience to evaluate wall motion abnormalities which are subjectively determined by the observer. In contrast, ultrafast computed tomography (UFCT) does not necessarily require extreme technical skill and experience. To evaluate the feasibility of stress UFCT with low-dose DOB, we scanned 10 normal subjects along the short-axis by 8-slice-multicine mode. After scanning at rest for baseline, we scanned during the administration of 4 and 8 m?g/kg/min of DOB, respectively, for 5 min. Ejection fraction, contraction, and thickening were higher during 8 m?g/kg/min of DOB than during 4 m?g/kg/min of DOB and baseline, while the above values were higher during 4 m?g/kg/min of DOB than during baseline (p < 0.01). It was possible to detect changes of cardiac function and wall motion due to low-dose DOB by UFCT. We therefore conclude that UFCT is a reliable modality for evaluating cardiac function and wall motion for low-dose DOB stress test because of its excellent spatial and contrast resolution.     

16层螺旋CT低剂量与常规剂量扫描的对照研究

目的通过对16层螺旋CT肺部低量与常规剂量扫描的对比分析，肺部低剂量检查的临床应用价值及优势。方法分析55例早期肺癌病变并经手术证实的患者，均为采用低剂量扫描体检时发现，短时间内又用常规剂量扫描，低剂量采用（120kV、20Eff．mAs），常规剂量采用（120kV、100Eff．mAs）扫描，对比分析两种扫描方法对病灶影像显示率及影像质量等因素有无差异性。结果低剂量扫描检查对病灶的显示与常规扫描检查均无明显差异，图像质量优良，纵膈窗图像噪声较大，但不影响纵膈内淋巴结及钙化的冠状动脉的显示。低剂量扫描剂量当量（CTDL）仅为常规扫描的20％。结论肺部CT扫描检查可采用低剂进行扫描，其对肺内病灶的显示与常规cT扫描无差别，并且可以明显减少患者的X线辐射剂量。     

小剂量利妥昔单抗为基础治疗32例免疫性血小板减少症疗效评价

目的 评估小剂量利妥昔单抗在免疫性血小板减少症（immune thrombocytopenia,ITP）治疗中的价值.方法 回顾性分析我院2009年1月-2012年12月应用小剂量利妥昔单抗（100 mg/周,连用4周）为基础治疗的32例免疫性血小板减少症患者的疗效.结果 32例ITP患者中可评估29例,完全反应18例,有效5例,无效6例,总反应率79.3％.新诊断ITP患者6例,完全反应1例,有效2例,无效3例;持续性ITP患者5例,完全反应4例,有效1例;慢性ITP患者18例,完全反应13例,有效2例,无效3例.先前治疗史：糖皮质激素有效17例,完全反应12例,有效2例,无效3例;糖皮质激素无效10例,完全反应6例,部分反应3例,无效1例.结论 小剂量利妥昔单抗在免疫性血小板减少症治疗中有较好的疗效,不良反应小,可作为有效的二线治疗手段.     

A Nurse Practitioner-led Centralized Lung Cancer Screening Program

Lung cancer is the leading cause of cancer-related deaths. Screening eligible high-risk individuals for lung cancer with a low-dose computed tomography scan is evidence based. A nurse practitioner centralized screening process was initiated to evaluate the impact on patient volume, follow-up compliance, and the length of time from diagnosis to treatment intervention. The implementation of a centralized lung cancer screening program standardization of practice resulted in a statistically significant improvement with follow-up recommendations and patient compliance compared with the established lung cancer screening process.     

应用小剂量肝素治疗急性呼吸窘迫综合症的临床疗效

目的探讨应用小剂量肝素治疗急性呼吸窘迫综合症(ARDS)患者的临床疗效。方法将我院重症医学科(ICU)住院治疗的明确诊断为ARDS的患者66人,随机分为试验组(34例)和对照组(32例),对照组给予常规治疗,试验组在常规治疗的基础上加用小剂量肝素(5～10 U/kg/h)持续泵入,测定两组间患者治疗前、治疗后第1天、第3天、第5天、第7天氧合指数(PaO2/FiO2)、呼吸频率(R)、血小板计数(PLT)、部分凝血酶原时间(APTT)、纤维蛋白原(FIB)、组织因子途径抑制物(TF-PI)。观察两组患者平均机械通气时间、平均ICU住院时间及28天病死率。结果与对照组相比,治疗后3、5、7天实验组PaO2/FiO2明显升高,R、TFPI含量明显下降,PLT、APTT、FIB含量无明显变化;对照组平均机械通气时间、ICU住院时间均显著低于对照组,28 d病死率较对照组有所降低。结论小剂量肝素治疗急性呼吸窘迫综合征疗效显著,临床应用安全。     

关于小剂量胰岛素治疗糖尿病酮症酸中毒的几个问题

本文总结1980～1981年期间采用小剂量胰岛素治疗44例糖尿病酮症酸中毒的经验。本组全部采用小剂量胰岛素2.4～12u/h加入生理盐水中持续静滴、直至血糖下降至250mg/dl。该法疗效良好、治愈43例(97.73%)、血糖降至250mg/dl平均需6.19±5.29h、胰岛素平均用量为31.9±23.7u,血糖每小时平均下降66.45mg/dl。本文着重讨论以下四点:1.本疗法对多数用过胰岛素治疗和胰岛素抗体存在者仍有效。2.分析了重症病人酮症纠正延迟的原因,并提出处理方法。3.指出糖尿病酮症酸中毒高渗性昏迷的处理方法。4 游离脂肪酸测定可作为糖尿病酮症酸中毒的诊断指标,有助于同非酮症高渗性昏迷的鉴别。     

Low-dose arabinosyl cytosine in acute leukemia after a myelodysplastic syndrome and in elderly leukemia

Low-dose arabinosyl cytosine (ARA-C) was tested in 15 patients with acute leukemia after a myelodysplastic syndrome (MDS) and in six elderly patients with acute nonlymphoid leukemia (ANLL). The drug was given subcutaneously at 10 mg/m2, every 12 hr for 2 weeks, every 28 days. The overall response rate was 19% (one complete remission, three partial responses), and the median duration of response was 4 months. No particular features at diagnosis were predictive of response. Pancytopenia and marrow hypoplasia occurred after 44 (78%) of 56 courses of therapy and were more severe in nonresponders. Four patients died during the aplasia following ARA-C therapy. Subcutaneous low-dose ARA-C was of limited benefit and bore a noticeable hematologic toxicity.     

Ovarian function during low-dose oral contraceptive use

Lowering the total steroid dose in modern oral contraceptives (OCs) has been connected with a higher incidence of ovarian follicle and cyst formation. To investigate the presence of ovarian follicles and cysts by means of vaginal ultrasonography and serum hormone determinations during use of two low-dose OCs, 65 volunteers were randomized to receive either 20 μg ethinylestradiol (EE) + 150 μg desogestrel (group A) or 35 μg EE + 250 μg norgestimate (group B) for a 2-month study period. At baseline, 39% of women in group A and 31% in group B exhibited at least one follicle <35 mm in diameter. By the end of the second treatment cycle, the frequency of these follicles had decreased to 14% in each group. Only one subject in the higher estrogen group developed an ovarian cyst >35 mm. One subject in each group demonstrated hormone levels characteristic of ovulation; no pregnancy occurred in either group. The 20 μg EE preparation was not found to lead more often to ovarian follicles or cysts when compared with a 35 μg EE preparation, possibly because of the type and dose of the progestogen used.     

小剂量阿糖胞苷治疗急非淋──骨髓内白血病原细胞的动态观察

综合早期的文献报道，小剂量阿糖胞苷诱导急非淋（ＡＮＬＬ）完全缓解，其缓解率达５０％～８０％之高，且认为此疗法无明显骨髓抑制和血液学毒性。综合近期的报道，此疗法的完全缓解率只有２２％～２３％，且常见血液学毒性、缓解期亦短。动态观察治疗前后骨髓原细胞的变化，解答了各家疗效如此悬殊和有关的问题。