Anisotropic Bladder Planning Target Volume in Bladder Radiation Therapy

Purpose

This study aimed to investigate 3 planning target volume (PTV) margin expansions and determine the most appropriate volume to be used in bladder preservation therapy when using daily cone beam computed tomography (CBCT). We aimed to establish whether a smaller PTV expansion is feasible without risking geographical miss.

Pediatric valve replacement, 15 years experience in Oman

Background Despite improving surgical techniques, treatment of heart valve disease in children remains controversial. Somatic growth and adequate anticoagulation are of concern when children undergo valve replacement. We conducted this study to evaluate the performance of valves in this age group. Methods 42 children under the age of 13 years who underwent valve replacement were included in this study. Totally, 50 valves were implanted in 42 patients: 48 were mechanical prostheses, two were bioprosthetic both in pulmonary position. 37 (74%) valves were implanted in mitral position, 10 (20%) in aortic position, 1 (2%) in tricuspid position and 2 (4%) in pulmonary position. Preoperatively, 14 (33,3%) patients were in New York Heart Association (NYHA) class IV, while 27 (64.2%) were in NYHA class III. Results There were 2 (4.7%) hospital deaths and 2 (4.7%) late deaths while 2 (4.7%) patients were lost to follow up. The mean follow up period was 9.4 yrs. 35 (83.3%) patients are in NYHA Class I and free of all medications except warfarin. 3 (7.1%) patients have undergone 5 successful pregnancies. The median INR was 2.23. Major thrombo-embolic episode occurred in 1 (2.3%) patient. Conclusions In view of the problems of sizing, anticoagulation and need for re-operation at an early age, there is a reluctance to replace valves in children. This study shows that despite these problems, valve replacement can be undertaken safely and successfully in children, when repair has failed or not technically feasible.     

维药买提布合爱普体猛汤治疗高脂血症疗效观察

传统维吾尔医学无“血脂”概念,更无“高脂血症”的病名,只是根据高脂血症的病因病机和临床表现,将高脂血症归属于“血浊”、“血浓”、“异常黑胆质性气质失调症”的范畴.维吾尔医学提出先用异常黑胆质成熟剂使体内的异常黑胆质得到易于排泄的状态,后用异常黑胆质清除剂排泄之,使血液恢复到正常状态.买提布合爱普体猛汤是“成熟及清除疗法”所用的“成熟剂”及“清除剂”的融合体,具备同时能成熟及清除所谓异常黑胆质的特点,     

Reconstruction of the wrist pseudoarthrosis due to radioulnar fractures with vascularized fibular graft in a child with neurofibromatosis

Nonunion in the forearm following a radioulnar fracture is one of the nightmares of the orthopedic surgeon. Fortunately, it is rare. We treated a large bone defect of the forearm, using a vascularized fibular graft after excision of the unhealed bone segment in a 10-year-old boy with neurofibromatosis. This situation followed a double fracture that had been operated on several times using conventional methods. Following the debridement of the unhealthy tissues in the pseudoarthrotic region, the vascularized fibula was placed on the dorsal surface of the proximal radius fragment. The distal fragment of the radius was inserted into the fibular cavity and fixation was established with a Kirschner wire distally and with a plate proximally. Only two screws were used to fix the plate. The peroneal artery was anastomosed with the radial artery; one of its venae comitantes was anastomosed with the cephalic vein in an end-to-end fashion. After surgery, the elbow was immobilized at 90 degrees of flexion with a splint for 6 weeks. One year after surgery, forearm stabilization and elbow and hand functions were very satisfactory. However, because the distal epiphyses of the bones were destroyed following the repeated surgery and the original trauma itself, a very prominent difference between the two forearms occurred, suggesting the need for bone lengthening in the future. By presenting this case we would like to conclude that one can expect good bone healing with a vascularized bone transfer in these cases when there is not enough space to place screws, but support can be provided by an external splint and K wire.     

维吾尔药玫瑰花口服液结合西药治疗44例心血管疾病的疗效观察

冠心病、高血压、心律失常等心血管疾病作为现代社会的多发病和常见病，已经引起医学界的广泛关注和高度重视。维吾尔医药基于维吾尔医药的特有理论和丰富的经验，借助现代医学先进的诊疗技术和科学手段，对部分常见的心血管疾病进行了大量的临床观察和深入的研究，取得了许多独具特色的成功经验和科研成果。我院在临床上自1991年开始应用玫瑰花口服液治疗心血管疾病，疗效显著。现仅在2005年治疗心血管疾病中随机抽样进行疗效观察。     

Neonatal necrotizing enterocolitis

PURPOSE: A retrospective, 12-year review of neonatal necrotizing enterocolitis was undertaken at a county hospital, with emphasis on presentation signs and symptoms. METHODS: Eighty-two patients with presence of intramural air were included in the study. The following signs and symptoms were studied: evidence of respiratory distress, use of umbilical catheters, white blood cell count and temperature at presentation, time interval from birth to diagnosis and time interval from diagnosis to operative intervention, presence of intramural air, air in biliary tree or free air, changes in abdominal girth, and presence of occult or gross blood in stools. Comparison was done among infants who had surgical or medical treatment, premature and full-term infants, and infants who had neonatal necrotizing enterocolitis less than or more than 20 days after birth. RESULTS: Eleven patients had a fatal outcome, with an overall survival of 87 percent. Sixty-four patients were treated medically and 18 had operative treatment. Mortality of the surgically treated group was 44 percent. Neonates who had surgical intervention had a left shift of the white blood cell count more commonly present, and all had documented abdominal distention. There were 62 premature and 20 full-term neonates in the group. Full-term neonates developed neonatal necrotizing enterocolitis earlier after birth (5.3 days compared with 15.3 days in the premature neonate group). Full-term neonates had a better prognosis in our series. Presentation of symptoms more than 20 days after birth did not change outcome. CONCLUSION: Our results reflect the experience of a community-based hospital. Clinical acumen remains the cornerstone of diagnosis and management.     

大隐静脉曲张激光闭合术时高位结扎与未高位结扎的近期复发率对比研究

目的 研究大隐静脉激光闭合术时高位结扎与未高位结扎对近期复发率的影响,明确大隐静脉激光闭合术时是否有必要附加大隐静脉高位结扎术。方法 将2004年3月至2006年3月接受大隐静脉激光闭合术的215例患者随机分为两组,A组：大隐静脉高位结扎加激光闭合术,B组：单纯大隐静脉激光闭合术,比较其术后复发率及并发症的区别。结果 随访6～29个月,1例失访,无深静脉血栓及肺栓塞发生。A组复发4例,复发率3.8%,B组复发9例,复发率8.3%,两组复发病例病因均为原发性深静脉瓣膜功能不全,单纯大隐静脉曲张术后无复发。经统计学分析,两组复发率无统计学意义（P〉0.05）。结论 没有证据表明行大隐静脉激光闭合术时首先行高位结扎更有优势,未高位结扎并不增加深静脉血栓形成及肺栓塞的发生机会。     

新疆维吾尔族慢性胃炎患者HLA-DRB1等位基因与幽门螺杆菌感染的关系

目的研究新疆维吾尔族慢性胃炎患者HLA-DRB1等位基因与幽门螺杆菌（Hp）感染的关系。方法采用幽门螺杆菌分离培养技术检测33例维吾尔族慢性胃炎患者幽门螺杆菌感染情况,采用PCR-SSP检测HLA-DRB1＊0405、HLA-DRB1＊08、HLA-DRB1＊12等位基因,并与36例汉族慢性胃炎患者进行比较。结果1）新疆维吾尔族慢性胃炎患者Hp阳性率（78.8%）显著高于汉族慢性胃炎患者（58.3%）（P〈0.05）;2）维吾尔族、汉族慢性胃炎患者Hp感染与HLA-DRB1＊0405、HLA-DRB1＊08、HLA-DRB1＊12等位基因无相关性（P〉0.05）。结论1）维吾尔族慢性胃炎患者Hp感染率高于汉族慢性胃炎患者;2）维吾尔族、汉族慢性胃炎患者Hp感染与HLA-DRB1＊0405、HLA-DRB1＊08、HLA-DRB1＊12等位基因无关。     

Glyceraldehyde-3-phosphate dehydrogenase: Nuclear translocation participates in neuronal and nonneuronal cell death

Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) protein levels increase in particulate fractions in association with cell death in HEK293 cells, S49 cells, primary thymocytes, PC12 cells, and primary cerebral cortical neuronal cultures. Subcellular fractionation and immunocytochemistry reveal that this increase primarily reflects nuclear translocation. Nuclear GAPDH is tightly bound, resisting extraction by DNase or salt treatment. Treating primary thymocytes, PC12 cells, and primary cortical neurons with antisense but not sense oligonucleotides to GAPDH prevents cell death. Because cell-death-associated nuclear translocation of GAPDH and antisense protection occur in multiple neuronal and nonneuronal systems, we propose that GAPDH is a general mediator of cell death and uses nuclear translocation as a signaling mechanism.