Irreversible electroporation of the pancreas-A decade on

Irreversible electroporation(IRE) employs the use of an electric field to cause irreversible permeability of the cell membrane, inducing apoptosis. The use of IRE for locally advanced pancreatic cancer(LAPC) was first described in 2012. The crucial advantage of IRE compared with other devices employing thermal ablation is the safety around vital structures such as vessels and ducts. This makes it an attractive option for use in the pancreas due to the close proximity of multiple major vascular s...     

Advances in the study of the effects of enteric α-defensins on the pathogenesis of inflammatory bowel diseases

防御素作为小肠腺泡底部潘氏细胞分泌的主要抗菌肽,具有广谱的杀菌、抗炎、抗病毒功能,对肠道的黏膜屏障功能和免疫功能都有非常重要的维持和调节作用.近年发现防御素和炎症性肠病(IBD)的发病联系紧密.现将近年来肠源性防御素在IBD发病机制中作用的研究进展进行综述,以期为今后IBD的治疗提供一定的理论依据.     

Commentary on the Chinese Translation of the CONSORT Extension for Harms

It is a great pleasure and honour forme to see the ex2tension oftheCONSORT statementforharms[1]trans2lated in theChinese language and published in theChi2nese Journal ofEvidence2BasedMedicine.The contri2bution ofChina to research in general and in medicalresearch in particular is expanding at a very rapid pace.Iwaspleasantly surprised a couple ofyears ago,when Ifirst realized that the number of Chinese biomedicaljournals is ofa similarmagnitude as the totalnumber ofthe mostly English2lan…     

Influence of the route of exposure and the matrix on the sensitisation potency of a major cows’ milk allergen

Background

Allergic sensitisation to food may occur through non-gastrointestinal routes such as via skin or lung. We recently demonstrated in mice that cutaneous or respiratory pre-exposures to peanut proteins on intact epithelia induce a Th2 priming and allow subsequent oral sensitization without the use of adjuvant. We then aimed to assess the impact of a similar pattern of exposure to another relevant food allergen, cows’ milk.

Findings

The humoral and cellular immune response induced in BALB/cJ mice after repeated cutaneous applications on intact skin or after intranasal administration of cows’ milk proteins was analysed. In order to assess the potential effect of the food matrix, we used either a purified major cows’ milk allergen, β-lactoglobulin (BLG), or whole cows’ milk containing the same amount of BLG. We then studied the impact of these pre-exposures on a subsequent oral exposure to milk in the presence or absence of the mucosal Th2 adjuvant, Cholera toxin (CT). Cutaneous applications of milk induced production of BLG-specific IgE and IgG1 in 5 and 8 mice out of 20 respectively, whereas purified BLG alone did not. Intranasal exposure to milk, but not to BLG, led to BLG-specific IgG1 production in 8 out of 20 mice. Notably, cutaneous pre-exposure to milk favours further oral sensitisation without CT, while intra-nasal pre-exposure to BLG prevents further experimental sensitisation.

Conclusions

Altogether, our results thus demonstrated that the immune response induced after non-gastrointestinal exposure to food depends on the allergen, the matrix and the route of exposure.     

Effect of the comprehensive rehabilitative treatment on rigidity of knee joint

ＢａｃｋｇｒｏｕｎｄＲｉｇｉｄｉｔｙｏｆｋｎｅｅｊｏｉｎｔｉｓａｃｏｍｍｏｎｃｏｍｐｌｉｃａｔｉｏｎａｆｔｅｒｔｈｅｐｏｓｔｏｐｅｒａｔｉｖｅｆｉｘａｔｉｏｎｏｆｌｏｗｅｒｌｉｍｂ＇ｓｆｒａｃｔｕｒｅｏｒｋｎｅｅｊｏｉｎｔ＇ｓｉｎｊｕｒｙｈａｓａｆｆｅｃｔｅｄｐａｔｉｅｎｔｓ＇ｌｉｖｉｎｇｑｕａｌｉｔｙａｎｄｉｓａｄｉｆ-ｆｉｃｕｌｔｐｒｏｂｌｅｍｏｆｔｈｅｒａｐｙｒｉｇｈｔｎｏｗ．ＯｂｊｅｃｔｉｖｅＴｏｏｂｓｅｒｖｅｅｆｆｅｃｔｏｆｔｈｅｃｏｍｐｅｒｈｅｎｓｉｖｅｒｅｈａｂｉｌｉ-ｔａｔｉｖｅｔ…     

Does the Experience of the Writer Affect the Evaluative Components on the Standardized Letter of Recommendation in Emergency Medicine?

Background

The Standardized Letter of Recommendation (SLOR) was developed in an attempt to standardize the evaluation of applicants to an emergency medicine (EM) residency.

Objective

Our aim was to determine whether the Global Assessment Score (GAS) and Likelihood of Matching Assessment (LOMA) of the SLOR for applicants applying to an EM residency are affected by the experience of the letter writer. We describe the distribution of GAS and LOMA grades and compare the GAS and LOMA scores to length of time an applicant knew the letter writer and number of EM rotations.

Methods

We conducted a retrospective review of all SLORs written for all applicants applying to three EM residency programs for the 2012 match. Median number of letters written the previous year were compared across the four GAS and LOMA scores using an equality of medians test and test for trend to see if higher scores on the GAS and LOMA were associated with less experienced letter writers. Distributions of the scores were determined and length of time a letter writer knew an applicant and number of EM rotations were compared with GAS and LOMA scores.

Results

There were 917 applicants representing 27.6% of the total applicant pool for the 2012 United States EM residency match and 1253 SLORs for GAS and 1246 for LOMA were analyzed. The highest scores on the GAS and LOMA were associated with the lowest median number of letters written the previous year (equality of medians test across groups, p < 0.001; test for trend, p < 0.001). Less than 3% received the lowest score for GAS and LOMA. Among letter writers that knew an applicant for more than 1 year, 45.3% gave a GAS score of “Outstanding” and 53.4% gave a LOMA of “Very Competitive” compared with 31.7% and 39.6%, respectively, if the letter writer knew them 1 year or less (p = 0.002; p = 0.005). Number of EM rotations was not associated with GAS and LOMA scores.

Conclusions

SLORs written by less experienced letter writers were more likely to have a GAS of “Outstanding” (p < 0.001) and a LOMA of “Very Competitive” (p < 0.001) than more experienced letter writers. The overall distribution of GAS and LOMA was heavily weighted to the highest scores. The length of time a letter writer knew an applicant was significantly associated with GAS and LOMA scores.     

Universal design and the challenge of diversity: reflections on the principles of UD,based on empirical research of people’s mobility

Abstract

Purpose: The author analyses some theoretical presuppositions of the Universal Design approach. She shows that it is based on two paradoxes: (1) it reduces diversity to the “universal”, (2) it depends on an asymmetrical view of abilities and disabilities. The author suggests a way of changing this concept in order to take into account uniqueness and diversity, in order to allow the shaping of abilities. Methods: The data are taken from an ethnographical survey carried out between 2007 and 2009 made up of in-depth interviews with wheelchair users and their families. The interviews were analysed inductively using the Nvivo© programme. Results: The mobility of people in wheelchairs, and their capacity to act, are linked to their particular experience and are the result of a process of adjustment and arrangement. This process involves specific and varied resources and leads to changes in the individuals, in their dis/abilites, but also in their perceptions. Conclusions: This analysis leads to a change in the question of policy. This question is no longer “how to include diversity using the definition of ‘universal’”, but “how to bring out and articulate this diversity, so as to vary the qualities of persons and the world in which they live”.

• Implications for Rehabilitation

• “Inaccessibility” is analysed in terms of a discrepancy between the user and her/his environment and in terms of experience.

• Accessibility is analysed as a process of adjustment and practical arrangements between the person and her/his environment.

• The universalism of Universal Design is criticized in the way it tries to force the variety of users into the uniqueness of one materiality.

• Emphasis is put on diversity and the necessity of articulating this diversity in a plural world offering various resources that individuals can call upon to act, depending on what they are and on what they want to become.

     

The influence of missing components of the Acute Physiology Score of APACHE III on the measurement of ICU performance

Objective To determine the impact of missing Acute Physiology Score (APS) values on risk-adjusted mortality.Design Retrospective review of prospectively collected Acute Physiology and Chronic Health Evaluation (APACHE) III database.Setting The intensive care units (ICUs) of an academic medical center.Patients 38,411 patients admitted to ICU between October 1994 and December 2003.Measurements and results Data were collected on ICU type, missing first ICU day APS values, predicted and observed hospital mortality, standardized mortality ratio (SMR), 95% confidence interval (CI), odds ratio (OR). The overall observed and predicted hospital mortality rates were 8.7% and 10.8%, respectively, with SMR of 0.806 (95% CI 0.779–0.834). Complete data were available in 829 (2.2%). Vital signs were missing in almost none and serum albumin and bilirubin in over 80% of the patients. The number of missing variables was higher in less sick and surgical ICU patients. Logistic regression analysis showed that the risk of dying in the hospital was significantly associated with the number of missing APS variables (OR 1.058, 95% CI 1.027–1.090) when adjusted for the severity of illness. The risk of death was also associated with the type of missing variables.Conclusions Since missing APS values may lead to underestimation of the predicted mortality rates, the number and type of missing variables should be taken into consideration when assessing the performance of an ICU. Unless data collection is standardized, future prognostic models should use variables that are routinely measured in most critically ill patients without sacrificing statistical precision.This article refers to the editorial:     

The effect of rehabilitation training on the treatment of infected artifidal joint

BACKGROUND: The key of curing infected-artificial joint is how to improve bone union and close surface of wound.OBJECTIVE:To explore the effect of rehabilitative training on the treatment of infected artificial joint of tibia.UNIT: Department of Orthopaedics, the 309th Hospital of PLASUBJECTS: 16 patients with infected artificial joint were recruited from May 1994 to July 2001, 12 males and 4 females, average 34 years. All the cases met the following criteria: (1 )The part of fracture was in middle or lower position of tibia; (2) Soft tissue defect of anterolateral surface of libra and exposure of libra and screw of steel plate, average area 14. 5 cm2; (3) Secondary infection after operation and fracture did not unite; (4) Duration of disease was more