Reinforcement of the suture line with an ePTFE graft attached with histoacryl glue in duodenal trauma.

BACKGROUND: Most duodenal injuries are managed with primary repair, but the degree of duodenal-wall injury may threaten the integrity of the primary repair. Therefore, we evaluated whether the primary repair site could be reinforced with histoacryl glue (HAG) or HAG with an expanded polytetrafluoroethylene (ePTFE) mesh. METHODS: Grade 3 duodenal injury in the second portion of the rat duodenum was chosen as a standard trauma model. Thirty-three male rats were divided into sham (n = 3), 2-layer primary repair (n = 10), 1-layer primary repair plus HAG application (n = 10) and ePTFE attached with HAG over the 1-layer primary repair site (n = 10) groups. Ten-day survival, adhesion grades and histological assessment were taken as outcome measures. RESULTS: A significant survival advantage was identified in the group that had an ePTFE graft attached with HAG over a 1-layer repair when compared with the group that had a 2-layer primary repair. Adhesion grades were found to be particularly increased in the group that had an ePTFE graft attached with HAG over the primary repair site, moderately increased in the primary repair plus HAG application group and lower in the 2-layer primary repair group. ePTFE graft application was found to be beneficial to coverage of the HAG-dependent empty spaces in the serosal layer. CONCLUSIONS: A primary repair site after duodenal trauma or a difficult duodenal stump can be reinforced with the application of HAG or ePTFE graft implantation with HAG.     

The impact of poverty on educational outcomes for children

Over the past decade, the unfortunate reality is that the income gap has widened between Canadian families. Educational outcomes are one of the key areas influenced by family incomes. Children from low-income families often start school already behind their peers who come from more affluent families, as shown in measures of school readiness. The incidence, depth, duration and timing of poverty all influence a child’s educational attainment, along with community characteristics and social networks. However, both Canadian and international interventions have shown that the effects of poverty can be reduced using sustainable interventions. Paediatricians and family doctors have many opportunities to influence readiness for school and educational success in primary care settings.     

周围性面神经损伤患者对侧神经支配的研究

目的　通过测定面神经损伤患者组及大学生志愿者组面神经各分支对侧神经支配率 ,探讨周围性面肌瘫痪恢复过程中面神经对侧代偿支配的问题。方法　分别测定大学生志愿者 2 2例( 2 2侧 )及 10 8例面神经损伤患者的面神经电图对其对侧神经支配率进行分析其中损伤组又按发病原因不同 ,分为医源性损伤组、Bell氏面瘫组和创伤性损伤组 ,测试损伤支数为Ⅰ支 76支 ,Ⅱ支 81支 ,Ⅲ支 88支 ,Ⅳ支 6 6支。结果　①损伤组 3组间对侧支配率差异无显著性 (P >0 0 5 ) ;②损伤组Ⅰ、Ⅱ支对侧支配率明显高于志愿者组 (P <0 0 0 1) ;③损伤组Ⅰ支对侧支配率明显高于Ⅱ支(P <0 0 0 1)。结论　面神经损伤后 ,存在对侧神经支配功能增强的表现     

Factors leading to hydrocephalus after aneurysmal subarachnoid hemorrhage.

Hydrocephalus is not a rare complication following aneurysmal subarachnoid hemorrhage. Hydrocephalus following subarachnoid hemorrhage can progress acutely (0-3 days), subacutely (4-13 days) or chronically (after 13 days). The predisposing factors leading to hydrocephalus after subarachnoid hemorrhage are not known exactly. This study assessed the predictive factors for the development of this condition. All patients presenting with subarachnoid hemorrhage between 1992-2001 were evaluated. All of them had initial computed tomography (CT) and hydrocephalus was diagnosed on CT scans. Age, gender, preexisting diabetes mellitus and hypertension, neurological state according to the Hunt and Hess scale at admission, Fischer grade on CT, the presence of intraventricular hemorrhage and localization of aneurysm were analyzed to see if there was any meaningful relationship between hydrocephalus and these factors. One hundred and fourteen patients with aneurysmal subarachnoid hemorrhage were evaluated. The incidence of hydrocephalus was 28.1 %. The incidence for acute hydrocephalus was 18.4 %, for subacute 5.2 % and for chronic 4.3 %. Sixty-nine percent of patients with hydrocephalus were graded as 3, 4 or 5 according to the Hunt and Hess scale on admission. Fifty-five percent of patients with hydrocephalus were graded as 3 and 4 according to Fisher grade on initial CT scan. Preexisting diabetes, higher Fisher grade and intraventricular hemorrhage were statistically significant predictors for the development of hydrocephalus. But only preexisting diabetes and higher Fisher grade were independent predictors according to multivariate analyses.     

Contraceptive potential of a mifepristone-nomegestrol acetate sequential regimen in women

The effectiveness of a sequential regimen consisting of mifepristone, 10 mg/day for 15 days, followed by nomegestrol acetate (NOMA), 5 mg/day for the next 13 days, for inhibiting ovulation and maintaining regular bleeding cycles was assessed in 10 surgically sterilized volunteers who were followed for one pretreatment and three treated cycles. Hormonal determinations in blood and urine, ovarian ultrasonography, bleeding records in all cycles and an endometrial biopsy taken on day 22-25 of the third treatment cycle were used to monitor the effects of treatment. During treatment, 24 monophasic (no sustained progesterone rise above 12 nmol/l) and six biphasic cycles were recorded. Nine follicular ruptures were detected echographically in these 30 treated cycles, five of which occurred in monophasic cycles. All follicular ruptures occurred on days 1-7 of NOMA treatment. Echographic and endocrine features of ovulatory cycles were both present in only four treated cycles (13.3%). Development of a secretory endometrium was achieved in all cases, but it was always irregular. Regular withdrawal bleeding occurred in all subjects and no adverse reactions were recorded. The ovarian and endometrial effects of this regimen justify testing its contraceptive effectiveness in phase 2 clinical trials.      

EB病毒LMP1在鼻咽癌细胞系中通过NF-κB、AP-1促进IL-8分泌

目的：探讨EB病毒LMP1分子致瘤机制，在已证实鼻咽癌细胞系中LMP1有效激活NF－κB 或AP－1的基础上，对LMP1是否通过NF－κB 或AP－1促进IL－8分泌进行探讨。方法：以稳定表达LMP1及其3种突变体，空白载体的鼻咽癌细胞系[HNE2-LMP1,NHE2-MLP1(1-185),HNE2-LMP1(1-231),HNE2-LMP1Δ187-351和HNF3－pSG5]及antisense-LMP1处理的HNF2－LMP1鼻咽癌的细胞系为材料，将IL－8报道质粒瞬时导入这些细胞系中，通过测定luciferase值以反映LMP1是否促进IL－8转录；将mut AP-1/IL-8-luc或IκB α（S32A／S36A）表达质粒导入HNE2－LMP1细胞系中，比较其IL－8报道活性，以确定LMP1是否通过AP－1或NF－κB 诱导IL－8转录；利用ELISA方法测定HNE2－LMP1，HNE2－pSG5,anti-sese-LMP1处理的HNE2－LMP1鼻咽癌细胞系中的IL－8浓度，进一步从蛋白水平上确定LMP1是否促进IL－8分泌。结果：与HNE2－pSG5相比，在HNE2－LMP1，HNE2－LMP1Δ187－351和HNE2－LMP1（1－231）细胞系中IL－8报道活性分别升高了原来水平的11．5，8．6和3．4倍，而HNE2－LMP1（1－185）对IL－8报道活性不影响。在HNE2－LMP1细胞系中IL－8蛋白水平提高了17．4倍，而antisense-LMP1则使HNE2－LMP1细胞的IL－8报道活性及蛋白水平分别下降到原来水平的18．3％和9．2％，导入mutAP-1/IL-8-luc或IκBα（S32A／S36A）的HNE2－LMP1细胞中IL－8报道活性分别下降到原有水平39％和26％，结论：鼻咽癌细胞系中LMP1可能通过NF－κAP－1促进IL－8表达。