Siebenj?hrige erfahrungen mit der ?dintraoperativen maschinellen autotransfusion? und ?pr?operativen plasmapherese? bei chirurgischorthop?dischen eingriffen

Zusammenfassung Bericht über ?dintraoperative maschinelle autotransfusion?, kombiniert mit ?pr?operativer plasmapherese?. Mit maschineller autotransfusion kann intraoperativer blutverlust durch rückführung eigener erythrozyten halbiert werden. In kombination mit pr?operativer plasmapherese werden weitere fremdblutkonserven eingespart. übertragung von infektionskrankheiten und erzeugung irregul?rer antikōrper kōnnen verhindert werden. Bei der derzeitigen AIDS-situation wird das infektionsrisiko auf null reduziert.      

乳腺积乳囊肿的诊断与治疗

本文报告乳腺积乳囊肿43例。讨论了发病原因及病理,特别提出局部肿块波动感试验阳性,A超检查显示液平段,试穿抽出乳汁,对诊断有肯定价值;治疗以手术切除为主,仅有7例穿刺抽吸乳汁得以治愈。     

Conditional estimation of sensitivity and specificity from a phase 2 biomarker study allowing early termination for futility

Development of a disease screening biomarker involves several phases. In phase 2 its sensitivity and specificity is compared with established thresholds for minimally acceptable performance. Since we anticipate that most candidate markers will not prove to be useful and availability of specimens and funding is limited, early termination of a study is appropriate, if accumulating data indicate that the marker is inadequate. Yet, for markers that complete phase 2, we seek estimates of sensitivity and specificity to proceed with the design of subsequent phase 3 studies. We suggest early stopping criteria and estimation procedures that adjust for bias caused by the early termination option. An important aspect of our approach is to focus on properties of estimates conditional on reaching full study enrollment. We propose the conditional‐UMVUE and contrast it with other estimates, including naïve estimators, the well‐studied unconditional‐UMVUE and the mean and median Whitehead‐adjusted estimators. The conditional‐UMVUE appears to be a very good choice. Copyright © 2008 John Wiley & Sons, Ltd.     

Die bronchopulmonale Dysplasie Frühgeborener

In very preterm neonates, bronchopulmonary dysplasia (BPD) complicates the course of respiratory distress syndrome, i.e., primary surfactant deficiency in a structural immature lung. In Germany, about 11 000 preterms having a gestational age below 32 weeks are born and treated in neonatal intensive care units per year. Within this high risk group, the rate of BPD is about 15%. Relevant prenatal risk factors include intrauterine inflammatory fetal reaction as a consequence of ascending maternal infections, intrauterine growth retardation apart from the main risk factor immaturity. Postnatal risk factors include genetic predisposition, mechanical ventilation, infections and hemodynamically relevant patent ductus arteriosus.Preventive measures include intratracheal surfactant administration; new studies indicate preventive effects of caffeine, vitamin A and hydrocortisone in a subgroup of neonates with prenatal fetal inflammatory response.Due to long-term detrimental effects of BPD on lung function and psychomotor development, further experimental and clinical studies are mandatory in order to continue to reduce the BPD rate.     

中美中学生对由父母原因引起的考试焦虑认知研究

目的：比较中国和美国的中学生对由父母原因引起的考试焦虑的认知情况。方法：采用“失败结果预期（FOE）”问卷中的由父母原因引起的考试焦虑12项，测量中美两国公立学校14、15岁的1215名中学生对考试焦虑原因的认知。结果：1．相似认知：两国学生在由父母原因引起的考试焦虑方面有类似的认知，包括父母会担心自己能否进入高一级学校、会让父母烦恼等。2．跨文化的差异：表现为中国学生更多是因为父母责备、辜负了父母期望或会让父母生气而导致考试焦虑；而美国学生更多是由于父母认为他们不能面对生活中的挑战而产生焦虑。3．性别差异：表现在美国的女中学生在7个项目上、中国的男中学生在2个项目上分别比本国异性有更大程度的焦虑（P〈0．05）。结论：中美中学生对由父母原因引起的考试焦虑方面有类似的认知，但存在文化差异和性别差异。     

Sauerstoff tragende L?sungen verbessern die Gewebeoxygenation im quergestreiften Hautmuskel nach kritischer Isch?miezeit

Zusammenfassung Fragestellung. Ziel der vorliegenden Untersuchung war, die Effekte der Sauerstoff tragenden freien H?moglobinl?sung (Diaspirin-crosslinked-H?moglobin, DCLHb) auf die kapillare Perfusion sowie die Oxygenation im quergestreiften Hautmuskelgewebe nach kritischer Isch?miezeit und nachfolgender Reperfusion zu analysieren. Material und Methode. Die kapillare Gewebeperfusion wurde anhand der funktionellen Kapillardichte im Hautmuskel des syrischen Goldhamsters quantitativ vor der Induktion einer 4-stündigen Isch?mie sowie nach 0,5 h, 2 h und 24 h Reperfusion mittels intravitaler Fluoreszenzmikroskopie erfasst (n=8 pro Versuchsgruppe). In separaten Tieren wurde nach demselben Versuchsansatz mit der Mehrdrahtoberfl?chenelektrode (MDO, Eschweiler, Kiel) die Gewebeoxygenation gemessen (n=8 pro Versuchsgruppe). Die Tiere der Testgruppe (n=8) erhielten 15 min vor der Reperfusion eine Kurzinfusion von 5 ml/kg KG DCLHb (Diaspirin-crosslinked-H?moglobin, 10 g/dl, Baxter, IL, USA). Die Kontrolltiere (n=8) erhielten ?quivalente Dosen einer isotonen Kochsalzl?sung (Braun, Melsungen). Ergebnisse. Die funktionelle Kapillardichte als Ma? für die L?nge von erythrozytenperfundierten Kapillaren pro Beobachtungsfeld war bei den Kontrolltieren in der Reperfusionsphase dramatisch vermindert, w?hrend bei den mit DCLHb behandelten Tieren signifikant h?here Werte nachweisbar waren (p<0,05). Diese Beobachtung spiegelte sich in einer vollst?ndigen Erholung des Gewebe-pO₂ bei den Behandlungstieren wider, was in Kontrolltieren nicht erreicht wurde. Schlussfolgerungen. Die Ergebnisse dieser Studie zeigen, dass die Sauerstoff tragende L?sung DCLHb nach kritischer Isch?mie und Reperfusion die nutritive Perfusion und Gewebeoxygenation gegenüber kristalloiden L?sungen verbessert. Die Anwendung derartiger L?sungen scheint unter den klinischen Bedingungen einer kritischen Isch?mie daher als viel versprechender adjuvanter therapeutischer Ansatz. Electronic Publication     

A review of serotonin toxicity data: implications for the mechanisms of antidepressant drug action.

Data now exist from which an accurate definition for serotonin toxicity (ST), or serotonin syndrome, has been developed; this has also lead to precise, validated decision rules for diagnosis. The spectrum concept formulates ST as a continuum of serotonergic effects, mediated by the degree of elevation of intrasynaptic serotonin. This progresses from side effects through to toxicity; the concept emphasizes that it is a form of poisoning, not an idiosyncratic reaction. Observations of the degree of ST precipitated by overdoses of different classes of drugs can elucidate mechanisms and potency of drug actions. There is now sufficient pharmacological data on some drugs to enable a prediction of which ones will be at risk of precipitating ST, either by themselves or in combinations with other drugs. This indicates that some antidepressant drugs, presently thought to have serotonergic effects in animals, do not exhibit such effects in humans. Mirtazapine is unable to precipitate serotonin toxicity in overdose or to cause serotonin toxicity when mixed with monoamine oxidase inhibitors, and moclobemide is unable to precipitate serotonin toxicity in overdose. Tricyclic antidepressants (other than clomipramine and imipramine) do not precipitate serotonin toxicity and might not elevate serotonin or have a dual action, as has been assumed.     

Assessment of anti-inflammatory activity of Poria cocos in sodium lauryl sulphate-induced irritant contact dermatitis

OBJECTIVE: In the present study, we evaluated the anti-inflammatory activity of Poria cocos (PoCo) on experimentally induced irritant contact dermatitis (ICD) in a repeated sodium lauryl sulphate (SLS) irritation model. METHODS: The anti-irritative effect of PoCo was evaluated with a visual score and quantified by non-invasive bioengineering methods, namely chromametry and transepidermal water loss. Three concentrations of PoCo in base cream DAC (amphiphilic emollient; German pharmacopoeia) were tested in a 4-day repetitive irritation test using SLS. RESULTS: A statistically significant anti-inflammatory activity was observed for PoCo by all three methods when applied in parallel to the induction period of ICD. Application of PoCo after induction of ICD once a day for 5 days, starting just at the end of 4 days, was without any effect. CONCLUSION: An anti-inflammatory efficacy of PoCo on the elicitation phase of the ICD induced by repeated SLS test could be observed and quantified by three independent, non-invasive biophysical assessment parameters. This effect can be explained by its influence on pro-inflammatory enzymes, namely phospholipase A2.