Magnetic resonance angiography for the primary diagnosis of pulmonary embolism: A review from the international workshop for pulmonary functional imaging

Pulmonary contrast enhanced magnetic resonance angiography (CE-MRA) is useful for the primary diagnosis of pulmonary embolism (PE). Many sites have chosen not to use CE-MRA as a first line of diagnostic tool for PE because of the speed and higher efficacy of computerized tomographic angiography (CTA). In this review, we discuss the strengths and weaknesses of CE-MRA and the appropriate imaging scenarios for the primary diagnosis of PE derived from our unique multi-institutional experience in this area. The optimal patient for this test has a low to intermediate suspicion for PE based on clinical decision rules. Patients in extremis are not candidates for this test. Younger women (< 35 years of age) and patients with iodinated contrast allergies are best served by using this modality We discuss the history of the use of this test, recent technical innovations, artifacts, direct and indirect findings for PE, ancillary findings, and the effectiveness (patient outcomes) of CE-MRA for the exclusion of PE. Current outcomes data shows that CE-MRA and NM V/Q scans are effective alternative tests to CTA for the primary diagnosis of PE.     

Quality of life,work productivity impairment and healthcare resources in inflammatory bowel diseases in Brazil

BACKGROUND Inflammatory bowel diseases(IBD) have been associated with a low quality of life(QoL) and a negative impact on work productivity compared to the general population.Information about disease control,patient-reported outcomes(PROs),treatment patterns and use of healthcare resources is relevant to optimizing IBD management.AIM To describe QoL and work productivity and activity impairment(WPAI),treatment patterns and use of healthcare resources among IBD patients in Brazil.METHODS A multicenter cross-sectional study included adult outpatients who were previously diagnosed with moderate to severe Crohn's disease(CD) or ulcerative colitis(UC).At enrolment,active CD and UC were defined as having a Harvey Bradshaw Index≥8 or a CD Activity Index≥220 or calprotectin 200 μg/g or previous colonoscopy results suggestive of inadequate control(per investigator criteria) and a 9-point partial Mayo score≥5,respectively.The PRO assessment included the QoL questionnaires SF-36 and EQ-5 D-5 L,the Inflammatory Bowel Disease Questionnaire(IBDQ),and the WPAI questionnaire.Information about healthcare resources and treatment during the previous 3 years was collected from medical records.Chi-square,Fisher's exact and Student's t-/Mann-Whitney U tests were used to compare PROs,treatment patterns and the use of healthcare resources by disease activity(a=0.05).RESULTS Of the 407 patients in this study(CD/UC:64.9%/35.1%,mean age 42.9/45.9 years,54.2%/56.6% female,38.3%/37.1% employed),44.7%/25.2% presented moderate-to-severe CD/UC activity,respectively,at baseline.Expressed in median values for CD/UC,respectively,the SF-36 physical component was 46.6/44.7 and the mental component was 45.2/44.2,the EQ-visual analog scale score was 80.0/70.0,and the IBDQ overall score was 164.0/165.0.Moderate to severe activity,female gender,being unemployed,a lower educational level and lower income were associated with lower QoL(P 0.05).Median work productivity impairment was 20% and 5% for CD and UC patients,respectively,and activity impairment was 30 %,the latter being higher among patients with moderate to severe disease activity compared to patients with mild or no disease activity(75.0% vs 10.0%,P 0.001).For CD/UC patients,respectively,25.4%/2.8% had at least one surgery,38.3%/19.6% were hospitalized,and 70.7%/77.6% changed IBD treatment at least once during the last 3 years.The most common treatments at baseline were biologics(75.3%)and immunosuppressants(70.9%) for CD patients and 5-AS A compounds(77.5%) for UC patients.CONCLUSION Moderate to severe IBD activity,especially among CD patients,is associated with a substantial impact on QoL,work productivity impairment and an increased number of IBD surgeries and hospitalizations in Brazil.     

保存12周的红细胞

现代液体红细胞保存体系运行良好,使一个国家供应的异体红细胞安全、廉价,并且有效率达到95％。现代红细胞保存系统在临床上用途广泛,如可为自身输血提供血液,可为战场上的手术输送血液,避免献血者接触新生儿,显然如果延长红细胞的保存期将会有更大的益处。然而,由于衰老的红细胞具有使血流不畅,细胞破裂后一些有毒性的脱出物可能使外伤病人的死亡率增加和导致输血相关急性肺损伤(TRALI),进一步研究建立更好的红细胞保存体系仍然很重要。     

Neuroendocrine signet ring cell adenocarcinoma of the endocervix

Abstract. Cardosi RJ, Reedy MB, van Nagell JR Jr, Spires SE. Neuroendocrine signet ring cell adenocarcinoma of the endocervix.
Signet ring cell morphology in mixed carcinoma of the uterine cervix is not uncommon. It is rare for such morphology to predominate, however, and there are no reported cases of a signet ring cell adenocarcinoma (SRCA) of the endocervix with neuroendocrine differentiation.
A 53-year-old woman presented with abnormal perimenopausal bleeding, and uterine curettings revealed a signet ring cell carcinoma. After clinical evaluation to eliminate a metastasis from an extra-uterine primary, the patient underwent surgical therapy and staging, and was treated with postoperative adjuvant chemoradiation. Pathologic evaluation found the tumor to arise from the endocervix and to be of predominant signet ring cell morphology. Immunohistochemical staining revealed that the tumor exhibited neuroendocrine differentiation and helped confirm its endocervical origin. The patient remains without evidence of disease 6 months after primary therapy.
This is the first case report of endocervical SRCA with neuroendocrine differentiation (SRCA with features of carcinoid tumor). Discussion of this entity is provided.     

An unbalanced half-cryptic translocation involving the 6q subtelomeric region and 2p25.3 in a child with mental retardation: uses and limitations of fluorescence insitu hybridization

We report on a 5-year-old boy with minor anomalies, growth retardation, and developmental delay carrying an extra chromatin material on the terminal band of the long arm of chromosome 6. To determine the origin of this extra material, whole chromosome fluorescence in situ hybridization (FISH) was used initially. Results showed fully painted 6qs, excluding the possibility of a derivative. However, maternal cytogenetic investigation suggested the presence of a possible half-cryptic balanced translocation that was further assessed using specific subtelomeric FISH probes of chromosome 6. Results showed that the 6q subtelomeric region was translocated on an A-group chromosome that was ultimately characterized, using FISH, as chromosome 2. This illustrates the use of specific subtelomeric regions and the limitations of whole chromosome FISH to identify the origin of a subtle chromosomal abnormality.     

人类免疫缺陷病毒阳性肺结核患者临床分析

目的 提高人类免疫缺陷病毒（ＨＩＶ）阳市肺结核（ＰＴＢ）的认识。方法 对赤道几内亚巴塔医院１９９６年１月～１９９９年１１月确诊的１６８例ＨＩＶ阳性ＰＴＢ进行分析。结果 ＨＩＶ在ＰＴＢ患的感染率由１９９６年的１１．４％升至１９９９年的２２．７％。患多急骤起病（９４．６％）,以近期消瘦（８２．１％）、全身关节酸痛（７８．６％）、皮肤瘙痒（４２．９％）、慢性腹泻（２３．２％）、浅表淋巴结肿大（２０．