Development of gait in spastic children with cerebral palsy

The gait of 50 spastic children 3-16 years old was recorded and analyzed. All children showed abnormal values of both basal parameters and phases of the stride. In gait velocity and stride length, their values were lower than normal, but they increased with age, with stride length increasing in parallel with normal values. Stride frequency showed a decrease with age, the reverse of normal. Stance and swing, when normalized with regard to stride duration, showed no change with age in spastic children. Also, stance was longer than in normal children, the same tendency as shown by double support. Hemiplegic children showed clearly asymmetric phases. The decreasing stride frequency with increasing age indicates a relative slowing of movements. Most changes with age were, however, the same as in normal children. The prolonged stance and double support suggest deteriorated postural control, resulting in an increased need of support.     

Urate homeostasis in polycystic kidney disease: comparison with chronic glomerulonephritic kidney

Autosomal dominant polycystic kidney disease (ADPKD) might affect urate homeostasis and clearance. Renal tubular urate transport was studied by means of probenecid (PB) and pyrazinamide (PZA) tests in individuals with ADPKD and normal renal function as well as various degrees of renal failure (49 patients). Comparisons were made between polycystic and chronic glomerulonephritic kidney (CGNK), as well as with controls (men with normal renal function). Patients with ADPKD and normal renal function showed plasma urate levels within normal range and normal renal urate handling. In contrast higher plasma urate levels comparing to controls were found in patients with CGNK and normal renal function. During the evolution of renal failure ADPKD patients showed lower urate plasma levels and higher renal clearance as well as, fractional urate excretion, comparing to CGNK patients with the same degree of renal failure. In conclusion patients with ADPKD and normal renal function have normal urate handling and plasma urate levels within normal range. With increasing severity of disease and during evolution of renal failure CGNK patients showed higher urate plasma levels and lower clearances comparing to ADPKD patients. When renal disease becomes more advanced there was no difference in renal urate handling between ADPKD and CGNK patients.     

Comparison of fibronectin content in urinary macromolecules between normal subjects and recurrent stone formers.

OBJECTIVES: Fibronectin (FN: 230 kD) is a multifunctional alpha(2)-glycoprotein distributed throughout the extracellular matrix and body fluids. Recent studies have shown that a variety of molecules, including FN, inhibit the endocytosis of calcium oxalate (CaOx) crystals in vitro. We recently reported that FN was oversecreted from the renal tubular cells as a result of the stimulation of CaOx crystals, and inhibited the aggregation of CaOx crystals and the adhesion of CaOx crystals to the renal tubular cells. In the present study, we investigated the difference of FN content in urinary macromolecules (UMMs) between normal subjects and recurrent stone formers. MATERIALS AND METHODS: Urinary parameters in relation to urolithiasis of normal subjects and recurrent stone formers were measured. Proteins in extracted UMMs from urine of normal subjects and recurrent stone formers were measured with a BioRad protein assay, GAGs in each UMMs with a modified DMB assay and the FN content with the ELISA method. RESULTS: In urinary parameters, citrate was significantly higher in urine from normal subjects (female) than normal subjects (male) or recurrent stone formers, and the other parameters showed no differences between each group. The protein concentrations in UMMs showed no differences between each group. Normal subjects (male and female) showed a significantly higher concentration of GAGs than recurrent stone formers (with and without silent stone). Compared with normal subjects and recurrent stone formers without silent stones, higher FN levels were found in recurrent stone formers with silent stones. Normal subjects showed a significantly higher concentration of FN than recurrent stone formers without silent stones. No difference in FN level was shown between normal subjects (male) and normal subjects (female). CONCLUSION: Recurrent stone formers with silent stones showed a significantly higher concentration of FN in UMMs than normal subjects. This finding suggests that FN might be oversecreted from the renal tubular cells as a result of the stimulation of CaOx stones in vivo. Recurrent stone formers without silent stones showed a significantly lower concentration of FN in UMMs than normal subjects. From this finding it is suggested that FN might play a role as a potent inhibitor of CaOx urolithiasis in a clinical setting.     

术中造影在胆道手术中的应用分析

目的比较术中胆道造影与术前影像检查的差异,分析其对胆道疾病的诊断及术式选择的指导价值。方法 118例胆囊结石和胆道疾病患者,术前24例行B超检查,发现正常胆管22例,胆总管结石1例,胆管扩张1例;69例行CT检查,发现正常胆管49例,泥沙样胆管结石16例,胆管扩张4例;25例行MRCP检查,发现正常胆管17例,胆总管结石6例,胆管扩张2例。术中行胆道造影,根据造影结果确定相应术式。结果术前行B超检查的24例中造影发现正常胆管15例,胆总管结石6例,胆管癌1例,胆囊管变异1例,Caroli氏病1例;术前行CT检查的69例术中造影发现正常胆管51例,胆总管结石10例,胆管癌1例,胆囊扩张2例,胆囊管变异1例,Mirizzi综合征2例,胆管损伤2例;术前行MRCP检查的25例,术中造影发现正常胆管14例,结石5例,胆管扩张4例,胆囊管变异1例,M irizzi综合征1例。术中胆道造影对正常胆管的识别能力优于术前B超(P0.05)。结论术中胆道造影具有操作简单、创伤小、结果可靠等优点,对胆道早期肿瘤、解剖畸形、术中胆道损伤的诊断及术式选择具有指导意义。     

Natural history of ultrasound hip abnormalities in clinically normal newborns.

One hundred one clinically normal newborn hips showed varying degrees of sonographic hip dysplasia according to the classification of Graf. None were treated, and after +/- 6 months, radiographs showed that only four had definite dysplasia. Of these, three had had risk factors such as breech delivery or familial predisposition. Forty-three other clinically normal newborn hips showed ultrasonic instability, which spontaneously corrected. The severity of ultrasound dysplasia at birth was not related to ultimate development of the hip. Our results indicate that ultrasound should not be performed as a general screening procedure in clinically normal newborns.     

膀胱癌和肾癌组织中RASSF1A基因的甲基化改变

目的研究RASSF1A基因启动子的甲基化状态及在膀胱癌和肾癌发生中的作用。方法采用甲基化特异性PCR(MSP)技术检测45例手术切除的膀胱癌组织和相应癌旁正常组织标本、9例电切膀胱癌组织、3例非肿瘤患者正常膀胱组织、12例肾癌组织和相应癌旁正常组织标本中RASSF1A基因的甲基化情况。结果膀胱癌组织中RASSF1A基因异常甲基化55.6%(30/54),其中手术切除组57.8%(26/45),电切癌组织异常甲基化4例,癌旁正常组织基因异常甲基化1例;肾癌组织中基因异常甲基化66.7%(8/12),相应癌旁正常组织中未发现基因甲基化。3例正常膀胱组织标本中未发现基因异常甲基化。膀胱癌组织中RASSF1A基因甲基化率有随组织分期升高的趋势,但与临床病理参数间无明显相关性。结论膀胱癌和肾癌组织中RASSF1A基因启动子高度甲基化,表明该基因甲基化可能与2种肿瘤的发生相关。     

X-ray microanalysis of teeth from healthy patients and patients with familial hypophosphatemia

Summary Energy-dispersive X-ray microanalysis was used to determine calcium/phosphorus (Ca/P) ratios in undecalcified teeth, and the sulfur (S) content of dentin of decalcified teeth from normal patients and patients with familial hypophosphatemia, in an attempt to determine the effect of phosphorus deficiency. The results showed that normal enamel has a slightly elevated Ca/P ratio compared to pure apatite. Enamel from a tooth of an untreated patient with hypophosphatemia exhibited a significantly higher Ca/P ratio than the normal teeth whereas enamel from teeth of an intermittently treated patient exhibited Ca/P ratios similar to pure apatite. Surprisingly, globular dentin in the same teeth showed a Ca/P ratio similar to that of globular dentin of the untreated tooth. The decalcified dentin from teeth of three hypophosphatemic patients and eight normal patients showed a S peak which varied widely in concentration. No detectable differences could be found between normal and diseased teeth.     

Hypoosmotic swelling test in normo-, oligo-, astheno- and oligoasthenozoospermic men before and after swim-up separation of spermatozoa

Semen samples from a total 58 men were examined by routine semen analyses and the hypoosmotic swelling test. Samples were classified as normal, oligo-, astheno- or oligoasthenozoospermic on the basis of spermatogram findings. The latter three groups showed a significant decrease in the percentage of HOS positive forms in comparison to normal spermograms. All these samples were treated with the swim up technique to select motile spermatozoa, using a procedure similar to that routinely employed in clinical settings for homologous intrauterine insemination (IUI). Following swim-up, the ejaculate supernatant and residual precipitate were subjected to the hypoosmotic swelling test (HOS test), and the percentage of normal forms was determined in the three groups. The results showed greater percentages of HOS positive, normal and HOS positive-normal forms in the group of normal individuals than in any of the other three groups. The supernatant used in IUI showed a significant increase in percentage HOS positive spermatozoa, normal forms and spermatozoa which were both normal and HOS positive in comparison with the other two groups in normal and oligozoospermic samples, but not in samples which presented suboptimal motility (astheno- and oligozoospermia). In conclusion, the swim-up technique is effective in separating high-quality spermatozoa in normo- and oligozoospermic samples, although its effectiveness with astheno- and oligoasthenozoospermic samples should be questioned.     

Clinical significance of telomerase activity in the non-cancerous epithelial region of oesophageal squamous cell carcinoma.

BACKGROUND: The aim of this study was to examine telomerase activity in affected and adjacent tissue in patients with oesophageal squamous cell carcinoma (SCC). METHODS: Telomerase activity was measured in oesophageal SCC cells, normal oesophageal culture cells, primary cancer tissues and adjacent normal tissues from patients with oesophageal SCC using a polymerase chain reaction-based assay. RESULTS: All oesophageal SCC cells had telomerase activity, whereas normal cultured cells showed no activity. All 57 cancer tissues showed telomerase activity compared with only five (10 per cent) of 50 normal tissues. Cancer cells infiltrating the vessels of mucosal or submucosal tissues in non-cancerous regions were detected in four of five telomerase-positive normal tissues, whereas such infiltration was detected in only three of 45 telomerase-negative normal tissues. CONCLUSION: In patients with oesophageal SCC, measurement of telomerase activity in normal epithelium is a highly sensitive method of detecting the microinvasion of cancer cells.     

Assessment of primary varicose veins with plethysmographic techniques

Venous hemodynamics were evaluated by simultaneous strain gauge- and photo-plethysmographic techniques in 40 normal limbs (normal group), 74 limbs with primary varicose veins (varicosis group) and 28 limbs with postthrombotic syndrome (thrombosis group). Furthermore, the venous function of 52 limbs with primary varicose veins was assessed before and after surgical treatment of varicose veins. The mean 1/2-refilling time in varicosis and thrombosis group was significantly shorter than that in normal group. With application of tourniquets, limbs in varicosis group showed improvement in 1/2-refilling time. Varicosis group showed a significantly higher value in expelled volume during exercise than thrombosis group, and no significant difference compared with normal group. With tourniquets, the value in varicosis group was higher than that in normal group. From these results, the pathogenesis of primary varicose veins might be characterized as a high degree of venous congestion of the leg and valvular incompetence of the superficial vein system. Postoperative recording showed the improvement in venous function. However, in early stage after the operation, all parameters were lower than those in normal group. These values normalized 3 months after surgery.     

胫骨-股骨单隧道双束解剖重建前交叉韧带

目的探讨胫骨-股骨单隧道双束重建前交叉韧带（ACL）的近期临床效果。方法对本组2009年4月至2011年4月收治的46例ACL损伤患者进行胫骨-股骨单隧道双束解剖重建ACL,先后钻取胫骨、股骨隧道,屈膝120。由前内侧入路建立股骨隧道,之后引入双束同种异体肌腱（或自体肌腱）,肌腱胫骨端、股骨端（沿肌腱间打入钉鞘形成双束）固定,术后随访,按照IKDC和Lysholm膝关节评分标准评价疗效。结果所有患者均获得1年以上随访。最后随访时,所有患者前抽屉试验阴性,45例患者（97．8％）Lachman试验阴性,1例患者Lachman试验I度阳性。KT-1000检查显示双侧膝关节前向松弛度差值平均为（-0．47±1．39）mm,手术前后有统计学差异（t=36．07,P〈0．01）;其中30例（65．2％）〈0mm,即患侧关节稳定度高于健侧;15例（32．6％）为0～2mm;1例（2．1％）〉2mm。所有患者轴移试验检查均为阴性。活动度检查发现42例伸屈活动度均正常,1例有5。屈膝欠缺,1例患者有10。屈膝欠缺,2例有5。过伸欠缺。从膝关节稳定性方面分析,45例（97．8％）IKDC评级为正常,1例（2．2％）评级为接近正常。综合分析,44例（95．7％）IKDC评级正常,2例（4．3％）为接近正常。术后IKDC膝关节主观评分为（94．9±3．7）分,Lysholm评分为（93．71±3．3）分。受伤前Tegner评分平均为7．3分,最后随访时为6．9分。结论对膝关节ACL断裂患者施行胫骨一股骨单隧道双束解剖重建,能够建立具有高度稳定性的膝关节,使所有患者获得IKDC评级正常或者接近正常的结果。     

Case study: erythrokeratodermia variabilis

A 4-year-old girl presented to the dermatology clinic with complaints of erythematous skin lesions on her face, extremities,forearms, and joints. The patient was a product of a full-term, normal pregnancy and delivery and was born to healthy parents. The parents are cousins. The condition started a few months after birth with small, hyperkeratotic patches on her cheeks. These lesions did not respond to the treatment that was given. The condition progressed and a few months later similar skin lesions started to appear on her forearms and knees. Different types of treatment, such as topical antibiotics,emollients, topical steroids, and systemic antihistamines, have been tried without any benefit. Some lesions showed variable exacerbations and remissions. There was no family history of a similar problem, although her older brother showed marginal hair loss without any skin lesions. On physical examination (Figures 1-3), hyperkeratotic erythrodermic plaques of variable thickness with sharply demarcated borders were seen on cheeks, extensor surfaces of forearms, and on the knees. The palms,soles, nails, and teeth were normal. The hair showed normal appearance, but there was no hair growth on the margins of the scalp. The laboratory investigations showed normal complete blood count and normal serum zinc and ferritin levels. Urine microscopy and examination was normal. Skin biopsy was taken and histopathology showed nonspecific features of hyperkeratosis with moderate papillomatosis and acanthosis (Figure 4). A diagnosis of erythrokeratodermia variabilis was made and the patient was started on emollients as treatment. There was not much improvement with the treatment.     

mRNA expression of topoisomerase II in human tumors and normal tissues

The cellular levels of topoisomerase II expression were compared between 10 fresh human tumors and normal tissues to predict the selective anticancer effect of its inhibitors such as adriamycin and VP-16. Topoisomerase II expression was observed in 9 of the 10 tumor tissues (90.0 per cent), 3 of which showed extremely high levels, whereas only 5 of the normal tissues (50.0 per cent) expressed any cellular topoisomerase II and the levels were not higher than those seen in the cancer cells. Six of the 9 positive tumors showed a higher level of topoisomerase II expression than the normal tissues, while the other 3 showed the same level. It can be interpreted from these results that topoisomerase II inhibitors could be effective in cancer patients due to the greater level of this enzyme in tumor cells than in normal tissues. Thus, it is suggested that a comparative analysis of topoisomerase II expression between tumors and normal tissues may be useful for predicting the selective cytotoxicity of topoisomerase II inhibitors in clinical practice.     

mRNA expression of topoisomerase II in human tumors and normal tissues.

The cellular levels of topoisomerase II expression were compared between 10 fresh human tumors and normal tissues to predict the selective anticancer effect of its inhibitors such as adriamycin and VP-16. Topoisomerase II expression was observed in 9 of the 10 tumor tissues (90.0 per cent), 3 of which showed extremely high levels, whereas only 5 of the normal tissues (50.0 per cent) expressed any cellular topoisomerase II and the levels were not higher than those seen in the cancer cells. Six of the 9 positive tumors showed a higher level of topoisomerase II expression than the normal tissues, while the other 3 showed the same level. It can be interpreted from these results that topoisomerase II inhibitors could be effective in cancer patients due to the greater level of this enzyme in tumor cells than in normal tissues. Thus, it is suggested that a comparative analysis of topoisomerase II expression between tumors and normal tissues may be useful for predicting the selective cytotoxicity of topoisomerase II inhibitors in clinical practice.     

Fibrogenesis imperfecta ossium (Baker's disease): a case studied at autopsy

A man aged 40 years showed radiographic changes in the form of generalized increased bone density and patchy rarefaction. Urinary calcium was increased and serum alkaline phosphatase was elevated; serum calcium and phosphate levels were normal. Multiple fractures developed. At autopsy, all parts of the skeleton showed partial replacement of bone and bone marrow by a tissue deficient in collagen fibers. Much of this tissue was unmineralized, but lesions in cortical bone showed hypermineralization on microradiographic examination. Electron microscopy showed replacement of collagen fibers by amorphous material in the affected areas. Electron probe analysis showed a normal Ca:P ratio for bone mineral in the hypermineralized areas.     

The prevalence, course, and characteristics of chronic anemia after heart and lung transplantation.

A retrospective study of the 99 surviving heart and lung transplant (HLT) recipients at one center showed that 31% had significant anemia (hemoglobin less than 100g/L) six months after transplantation. Chronic anemia persisted in 18% of HLT recipients two years posttransplantation. A similar study of 100 heart transplant recipients showed no unexplained anemic patients. The prevalence of anemia after HLT was unrelated to the original diagnosis, immunosuppression, or acute rejection. All HLT recipients appeared to be unduly sensitive to the myelosuppressive effects of azathioprine. Detailed studies in 16 representative patients showed a normochromic, anisocytotic anemia with normal reticulocyte counts, B12 and folate levels, and haptoglobin levels and appropriate erythropoietin levels--but increased ESRs, low/normal iron levels and low/normal total iron binding capacity, normal or raised ferritin levels, and autoantibodies in 4 (25%). Bone marrow aspirates in 10 patients showed dyshemopoiesis out of proportion to the degree of anemia and colonies of activated lymphoid cells. The cause for this anemia appears to be a combination of anemia of chronic disease and dyshemopoiesis, both of uncertain etiology.     

Pulse oximetry as a means of assessing bowel viability

Utilizing a pulse oximeter, oxygen saturation was determined in the periphery (tongue) and compared to the intestinal wall in a canine model. Segmental intestinal ischemia was then produced and the last obtainable pulse oximetry reading was marked with a suture on either end of the ischemic segment. Reexploration was performed within 48 hr and full thickness biopsies were taken in normal intestine and at various distances into the ischemic segment. Blinded evaluation of the biopsies showed that all biopsies taken within 1 cm of a normal pulse oximetry reading were normal, whereas at 3 cm into the ischemic segment 7 of 15 biopsies showed partial necrosis and 5 of 15 showed full thickness necrosis. We conclude that pulse oximetry of the intestinal wall is a valuable method of assessing intestinal viability in this model.     

组织扩张与机械牵拉对皮肤组织表达硫氧还蛋白影响的初步研究

目的 探讨硫氧还蛋白(TXN)在扩张皮肤组织与正常皮肤组织中的表达差异.方法 选取近两年在我院行额部扩张器取出术的患者13例,收集患者额部扩张器张力最大点(扩张组)以及颞部行附加切口处(对照组)的全层皮肤.免疫组织化学染色、Western blot检测TXN蛋白在扩张皮肤组织及正常皮肤组织中的表达.结果 免疫组织化学检测发现,扩张皮肤组织中TXN阳性细胞明显多于正常皮肤组织(P＜0.05);Western blot检测发现,扩张皮肤组织中TXN表达高于正常皮肤组织.结论 扩张皮肤组织中TXN蛋白表达高于正常皮肤组织,为进一步研究TXN在组织扩张中的作用提供理论基础.     

Measurement of limb blood flow by electrical impedance plethysmography.

Limb blood flow has been measured in 72 individuals by the noninvasive technique of electrical impedance plethysmography. Venous occlusion was not used. Blood flow was measured in 230 limbs in which 195 limbs were either in normal individuals or the clinically normal limbs of patients (normal limbs). Thirty-five limbs were clinically abnormal. Measurements on limbs with clinical abnormalities showed that blood flow values often fell within the limits of the normal range. However 3 cases of known vascular injury and 2 cases studied after hand surgery under tourniquet showed lowered blood flow values by comparison with the unaffected limb. A simultaneously recorded range of cardiac output and stroke volume measurements gave similar results to those obtained in a previous, unconnected study.     

保留并牵张残留纤维的前十字韧带双束重建术

目的 评估在亚急性期进行保留并牵张残留纤维的前十字韧带双束重建的临床效果.方法 2006年1月至2006年6月,对56例前十字韧带损伤患者在亚急性期进行保留并牵张残留纤维的前十字韧带双束重建.前十字韧带双束重建采用四隧道八股肌腱移植的方法.使用PDS缝线穿缝胫骨侧残留纤维,经深束股骨隧道牵张固定.使用IKDC及Lysholm评分标准评估疗效.结果 53例随访2年以上.末次随访时所有患者Lachman试验均为阴性.屈膝25°KT-1000检测结果显示双侧膝关节松弛度差值为(-0.44±1.53)mm,与术前(8.01±1.83)mm比较差异有统计学意义(t=37.03,P=0.0001).29例(54.7%)双侧膝关节松弛度差值小于0mm,提示患膝相对于健侧更为稳定或紧张.24例(45.3%)双侧膝关节松弛度差值为0～2mm.所有患者轴移试验均阴性.48例膝关节活动度正常,2例有5°屈曲受限,1例有小于5°屈曲受限,2例有5°过伸受限.根据IKDC评估标准,51例(96.2%)正常,2例(3.8%)接近正常.IKDC主观评分为(95.6±3.1)分,Lysholm评分为(94.8±2.9)分.受伤前Tegner评分平均为7.3分,末次随访时为7.1分.结论 根据2年以上随访结果,以IKDC为评估标准,保留并牵张残留纤维的前十字韧带双束重建能够使96.2%的患者恢复正常,3.8%的患者接近正常.