Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

彩色多普勒能量图在肝泡状棘球蚴病与肝癌鉴别诊断中的应用

目的　探讨彩色多普勒能量显像 (CDE)在肝泡状棘球蚴病 (HAE)与原发性肝癌 (HCC)鉴别诊断中的作用。方法　常规二维超声检查后进行CDE检测 ,观察 2 3枚HAE病灶与 2 0枚HCC病灶血流供应状况 ,记录病变周边及内部血流分布特征。结果　 2 1枚HAE灶内部未显示血流信号 ,而 3枚HCC灶内部亦未检出血流。两组病灶比较内部血流分布差异有显著性意义 (P <0 .0 0 1)。结论　HAE内部乏血供 ,而HCC内部为多血供。作为二维灰阶显像的补充 ,CDE对HAE与HCC具有重要的鉴别诊断作用     

Prevention of mother-to-child transmission of HIV Type 1: the role of neonatal and infant prophylaxis

The prevention of mother-to-child transmission (PMTCT) of HIV is one of the great public health successes of the past 20 years. Much concerted research efforts and dedicated work have led to the achievement of very low rates of PMTCT of HIV in settings that can implement optimal prophylaxis. Though several implementation challenges remain, global elimination of pediatric HIV infection seems now more than ever to be an attainable goal. Often overlooked, the role of prophylaxis of the newborn is nevertheless a very important component of PMTCT. In this paper, we focus on the role of neonatal and infant prophylaxis, discuss mechanisms of protection, and present the clinical trial-generated evidence that led to the current recommendations for preventing infections in breastfed and non-breastfed infants. PMTCT of HIV should not end at birth; a continuum of care extending postpartum and postnatally is required to minimize the risk of new pediatric HIV infections.     

Brief history of quality movement in US healthcare

The current healthcare quality improvement infrastructure is a product of a century long experience of cumulative efforts. It began with an acknowledgement of the role of quality in healthcare, and gradually evolved to encompass the prioritization of quality improvement and the development of systems to monitor, quantify, and incentivize quality improvement in healthcare. We review the origins and the evolution of the US healthcare quality movement, identify existing initiatives specific to musculoskeletal care, outline significant challenges and opportunities, and propose recommendations for the future. Elements noted to be associated with successful healthcare quality improvement efforts include the presence of physician leadership, infrastructural support, and prioritization of healthcare quality within the culture of the organization. Issues that will require continued work include the development of a valid and reliable evidence base, accurate and replicable performance measurement and data collection methods, and development of a standard set of specialty specific performance metrics, with accurate provider attribution, risk adjustment and reporting mechanisms.     

Intérêt du Télos dans l'évaluation de la laxité chronique antérieure du genou en pré- et en postopératoire

The objective of our work is to clarify the contribution of knee arthrometer in the diagnosis of the anterior laxity of the knee, to look for the factors of escalation of this pathology, to estimate the objective results and outcomes following of the anterior cruciate ligament surgery. It is about a retrospective study which concerned 78 patients presenting the anterior chronic laxity of the knee, investigated, treated and followed in the M.-T.-Kassab Institute of Orthopaedics over a period of 10 years. The average age of our patients was of 27.6 years with a male ascendancy. The anterior cruciate ligament surgery was realized according to the technique of Kenneth-Jones under arthroscopy. The arthrometer has been used to determine the outcome 6 months after the surgery. Before the surgery, the average anterior translation of the tibia was 15.3 mm, 95% of the patients had 8 mm previous absolute laxity, while the differential was about 4 mm in 87% of the cases in which comparative study could be made. There was a statistically significant correlation between the Lachman's test, the internal meniscus injuries and the delay accident — surgery with the anterior knee laxity in the arthrometer. The postoperative average laxity was bout 8.2 mm and earning was proportional to the importance of the initial tibial translation. The present study demonstrates that arthrometer tests may be an objective complement for the clinical exam, with a diagnostic, previous and therapeutic purpose.     

Studies of selected enzymes of phospholipid metabolism in the dystrophic human muscle

Proceeding from deviations of the phospholipid pattern in the muscle in progressive muscular dystrophy, the activities of a number of enzymes of phospholipid metabolism in the normal and dystrophic human muscle were measured. Twelve cases of the Duchenne type and four of the Becker-Kiener type were studied.The activities of CDP-choline:diglyceride-P-cholinetransferase, of CDPcholine: ceramide-P-cholinetransferase and of phosphatidylcholine degradation were determined in normal and dystrophic human muscle. A significant difference in enzyme activities between normal and dystrophic muscle could not be established. The activities of a phosphatidylethanolaminemethyltransferase and a transfer of P-choline directly from phosphatidylcholine to sphingomyelin could be excluded for normal human muscle.The significance of these results for the integration of phospholipid findings in ideas about pathogenesis of progressive muscular dystrophy is discussed.     

Multi-focal motor neuropathy: one treatment works but many uncertainties remain

The activity of a set of peptidases (proteases) involved in cancer progression is collectively known as the cancer ‘degradome’. Invasion and metastasis were initially considered as late events in cancer development and the processes in which proteases were involved. However, recent studies indicate that invasion and metastasis are not late events, but can occur during early stages as well. Moreover, other processes occurring in various stages of cancer progression are also protease-dependent, such as (upregulation of) cell proliferation, (downregulation of) apoptosis, involvement of white blood cells, angiogenesis and induction of multi-drug resistance. Proteolytic activity in tumours is regulated in a complex manner, as both genetically unstable cancer cells and stable stromal cells, such as fibroblasts, endothelial cells and inflammatory cells, are involved. In vitro studies and studies using animal models have clearly shown protease dependency of many processes in carcinogenesis. However, clinical trials using protease inhibitors have thus far been unsuccessful except for a few applications of matrix metalloprotease (MMP) inhibitors when used in combination with cytostatic anticancer agents and/or in the early stages of cancer. Antithrombotics, such as low-molecular-weight heparin and warfarin, were also successful in clinical trials, probably by interfering with proteases of the coagulation cascade. The two-way association between cancer and thrombosis has long been recognised in the clinic. The poor outcome of other clinical trials of protease inhibitors is probably due to the late stages of cancer of the patient populations included, and the limited understanding of the complex regulation and effects of the activity of the various proteases in tumours depending on, among others, tumour type and stage, interactions between the cancer cells, other cells and the extracellular matrix in tumours. Therefore, a better fundamental understanding of the proteolytic complexity in tumours is essential before clinical trials can be rationally designed. At present, antithrombotics, the urokinase-type plasminogen activator system, the membrane-bound membrane-type 1-MMP, cathepsin L and the proteasome seem the most promising candidates as targets for anticancer strategies in early stages of cancer in combination with cytotoxic drugs. Moreover, metronomic therapy is an attractive approach using low doses of inhibitors for prolonged periods of time without interruption to specifically target endothelial cells that are involved in angiogenesis.     

Mesenteric venous thrombosis presenting as gastrointestinal bleeding,a challenging diagnosis

Acute mesenteric venous thrombosis (MVT) is an uncommon cause of intestinal ischemia and is associated with high morbidity and mortality. Patients with acute MVT often present with gastrointestinal (GI) bleeding and other unspecific findings making the diagnosis challenging. This condition requires emergent treatment. The high rates of misdiagnosis of these patients and subsequently the delay in proper and quick management put patients at increased risk of having a negative outcome. Physicians should suspect acute MVT in patients with GI bleed while also considering other factors such as, a past medical history of pro-thrombotic conditions, past surgical history of splenectomy, symptoms of nausea, vomiting, abdominal pain, physical exam findings of abdominal tenderness and abdominal distention and a laboratory workup indicating leukocytosis and an increased plasma lactic acid level. An increase in the yield of accurate diagnosis of acute MVT is possible if physicians in the ED accurately interpret all these findings. The authors herein present a case of acute MVT in a patient whose initial complaint was GI bleeding and provide a thorough review of the literature of cases of acute MVT presenting with GI bleed.     

A modelled carbon account for Australia's post-1990 plantation estate

Australia's national carbon account for afforestation and reforestation activities qualifying under Article 3.3 of the Kyoto Protocol between 2008 and 2012 can be estimated using a carbon accounting model supported by a range of forest-related data. Using inventories of current plantation areas and projected expansion of the plantation estate, it is possible to project carbon sequestration in 36 known plantation management regimes to give an annual national account of net (sequestration minus emissions) carbon stock change.

Data for the modelling were provided through a range of studies undertaken for the development of the National Carbon Accounting System (NCAS). These included compendiums of available information on management regimes, plantation growth and yield, wood density, carbon contents and allocations to non- stem components of trees.

Future refinements of the modelling will include the extraction of a ‘mask’ of relevant afforestation and reforestation activities from the continental multi-temporal Landsat satellite coverages of Australia developed for the NCAS. Other improvements will include the use of the NCAS national annual 1 km grid productivity mapping to determine variability in growth associated with variability in climate and soil characteristics. Soil carbon modelling capability using the Roth C model will also be possible when the spatial mapping is complete and details of plantation areas can be merged with the relevant maps of soils and climate.     

Mechanisms and markers of carcinogenesis and neoplastic progression

Neoplastic transformation evolves over a period of time involving the progression of the cellular immunophenotype (IP) from normal to hyperplastic to dysplastic, and finally, to fully malignant IPs. Superimposed on these changes is the interaction of the initiated cell with its microenvironment, whereby the neoplastically transformed cells, through the regulation or dysregulation of cytoskeletal, integrin, protease and adhesion molecules, develop a novel manner of relation with their surrounding microenvironment. Studies of the neuroendocrine-immune network revealed that the hormonal and cytokine milieu plays an important role impacting the growth and dedifferentiation capabilities of neoplastic cells. This is further affected by the tumour cells themselves determining the constitution of this hormonal microenvironment, allowing the most aggressive and invasive of neoplastically transformed cell clones to promote their own growth and dissemination. The elucidation of the steps of the progression of cancer from premalignant to metastatic and invasive forms is of utmost importance in the differential diagnosis of neoplasms and in the establishment of more efficacious therapeutic regimens. These regimens will certainly begin to take on a more individualised form. The functional characterisation of various human malignancies as to the neoplastically transformed cells’ IP, the bases of their interaction with tissue stromal elements, and the molecules involved in the humoral microenvironment of the particular stage of tumour will certainly allow for the better diagnosis, staging, prognostication and treatment of cancers in the future. This paper reviews carcinogenesis from nutritional, genetic and molecular, and humoral aspects, and discusses the importance of tumour markers in the diagnosis and therapeutic management of human cancer.     

L’apport du muscle pectoralis minor dans le traitement de l’instabilité antérieure de l’épaule

The surgical stabilization of the shoulder knew many technical improvements energy. We propose a preliminary study about an engineering change by the addition of a fourth muscular bolt for the treatment of former instabilities of the shoulder. Our study is prospective gathering 16 patients having a stabilization of the shoulder by a quadruple locking using an osseous thrust by the coaracoid process, a tendineux bolt by a hammock applied thanks to the coaraco-biceps tendon to the lower bank of the sub-scapularis, a capsular bolt by joining the acromio-coracoid ligament to the glenohumeral capsule and a fourth bolt by the joining of the pectoral small tendon to the coraco-biceps. Our results evaluated by the score of Dupaly after 18 months show that the average retreat are satisfactory with an early resumption of the activity (2 months on average). The techniques of former stabilization of the shoulder are currently allowing that triple locking is indicated among all patients whose score ISIS exceeds five points. The addition of small pectoral as fourth bolt seems to us as well interesting because of the good preliminary results.     

Eater and draper are involved in the periostial haemocyte immune response in the mosquito Anopheles gambiae

Haemocytes respond to infection by phagocytosing pathogens, producing the enzymes that drive the phenoloxidase‐based melanization cascade, secreting lytic factors, and producing other humoral proteins. A subset of haemocytes, called periostial haemocytes, aggregate on the surface of the heart of mosquitoes and kill pathogens in areas of high haemolymph flow. Periostial haemocytes are always present, but an infection induces the recruitment of additional haemocytes to these regions. Here, we tested whether members of the Nimrod gene family are involved in the periostial immune response of the African malaria mosquito, Anopheles gambiae. Using organismal manipulations, RNA interference (RNAi) and microscopy, we show that, following an infection with Escherichia coli, nimrod – the orthologue of Drosophila NimB2 – is not involved in periostial responses. At 4 h postinfection, however, RNAi‐based knockdown of draper results in a marginal increase in the number of periostial haemocytes and a doubling of E. coli accumulation at the periostial regions. Finally, at 24 h postinfection, knockdown of eater decreases the number of periostial haemocytes and decreases the phagocytosis of E. coli on the surface of the heart. Phagocytosis of bacteria is more prevalent in the periostial regions of the mid abdominal segments, and knockdown of draper, nimrod or eater does not alter this distribution. Finally, knockdown of Nimrod family genes did not have a meaningful effect on the accumulation of melanin at the periostial regions. This study identifies roles for eater and draper in the functional integration of the mosquito immune and circulatory systems.     

Reflections on the Judgement Axis,ICNP beta. International Classification of Nursing Practice

This article presents questions, reflections and proposed resolutions regarding the Judgement Axis of the International Classification of Nursing Practice, Beta Version (ICNP beta). The Judgement Axis, in its present format, consists of an alphabetical listing of terms that are meant to reflect the clinical opinion of a nurse relating to the state of a nursing phenomenon appearing in Axis A of the ICNP beta. A review of literature indicates that judgement can be more extensive. Not considered in the development of the Axis is the fact that judgement can be clinical and actuarial. Actuarial judgement is predictive and based on statistics. Clinical judgement is patient-centred, creative and intuitive. Both are essential in defining nursing judgement. The list presents 49 modifiers in nominal form. Each of these is subordinated, in alphanumeric descending order, by qualifiers that do not conform to the concept of lexical hierarchy. We propose that the 49 terms which appear in the present listing as unique ordinates should be clustered into major categories with synonyms listed as subordinates of the major cluster headings. The qualifiers of degree, which are presently identified as subordinates in Axis B, might be presented in matrix format, providing a scale of degree of the modifier for the nurse.     

Early and late apoptotic events induced in human glioblastoma cells by Hypericin PDT

During photodynamic therapy (PDT) the interaction between light and photosensitizers induces oxidative stress and the production of reactive oxygen species (ROS). ROS formation influences ion channels and causes changes in the Ca²⁺ concentration which may induce further reactions leading to cell stimulation or cell death. In this study we analysed the influence of irradiation conditions on the cell death mechanisms during Hypericin-induced PDT. The process of apoptosis is characterized by morphological and physiological changes of the cell membrane and of the whole intracellular chain reactions. The translocation of the phospholipid phosphatidylserine from the inner to the outer leaflet of the plasma membrane is one of the earliest indications of apoptotic cell death. The translocation was traced by the binding of fluorescein isothiocyanate (FITC)-conjugated Annexin-V to phosphatidylserine and fluorescence activated cell sorting (FACS) analysis.     

正常人脑壳核苍白球MRI T2信号变化规律（兼析Shy－Drager综合征壳核短T2信号）

本文对100例不同年龄正常脑MRI壳核，苍白球进行T2信号之观测，并对20例经Perl‘s铁反应染色相应部位之脑标本测定光密度，结合标本MRI与病理对照研究正常脑壳核，苍白球T2信号变化规律，同时对Shy-Drager综合征患者壳核短T2信号进行探讨，结果提示：壳核，苍白球T2信号之变化与铁沉积有关，并与年龄增长具有相关性，但二者变化曲线不同，并提示中枢神经系统变性病如Shy-Drager综合征可能是一种有价值的信号。     

彩色多普勒超声对开角型青光眼的血流动力学研究及临床意义

目的了解开角型青光眼视神经的血液供应情况。方法用彩色多普勒超声检测开角型青光眼和正常眼眼动脉、视网膜中央动脉和睫状后动脉的收缩期峰值血流速度、舒张末期血流速度、时间平均血流速度、阻力指数和搏动指数。结果在两者之中眼动脉和睫状后动脉的收缩期峰值血流速度差异无显著性（Ｐ＞０．０５）,舒张末期血流速度、时间平均血流速度、阻力指数、搏动指数差异有显著性意义（Ｐ＜０．００１）。视网膜中央动脉的多项血流动力学指标差异有显著性意义（Ｐ＜０．００１）。结论开角型青光眼的视神经存在缺血因素。     

Benner's remnants: culture,tradition and everyday understanding

BACKGROUND: Benner's account of meaning and embodiment in nursing depends on a theory which she has never fully articulated, although she makes numerous allusions to it. Behind the background of shared meanings hovers something called 'culture', which provides each individual with meaning, determines what counts as real for her, and actively hands down interpretation-laden practices. This view is based, Benner claims, on the Heideggerian assumption that the meaning and organization of a culture precedes individual meaning-giving activity. AIM: I explore Benner's implicit view of culture, drawing on her published work over 15 years, and offer an appraisal of it. In doing so, I attempt to make sense of some rather strange remarks Benner has recently made about 'remnants' of Cartesian and Kantian thinking being found in the everyday understandings of people with asthma. METHODS: The concept of culture is developed with reference to both Benner's own work and that of the anthropologist, Clifford Geertz, whose work she frequently cites. Having identified the principal tenets of what we might conveniently call the Benner-Geertz theory, I proceed to interrogate the theory, using the recent anthropological literature -- and, in particular, materialist attacks on the idea of culture as a system of meanings -- in order to cast doubt on it. I also review, very briefly, an alternative way of understanding 'culture', which is not vulnerable to the same criticisms. CONCLUSIONS: Benner's implicit theory of culture is revealed, somewhat ironically, as an inverted form of Cartesian dualism. Its intellectual provenance is not Heidegger, who appears to reject it, but the sort of American sociology associated with Talcott Parsons. As a corollary, it is suggested that Benner's 'remnants' analogy cannot be justified, and that the idea of Cartesian and Kantian concepts permeating Western culture, infecting both the providers and receivers of health care, is a myth.     

Quanititation of gene expression by means of HPLC analysis of RT-PCR products

After elucidating the controversy that accompanied the birth of laboratory medicine, the Authors define and examine the concepts underlying clinical methodology. The mental operations of the clinician are analyzed, a distinction being made between the processes of: a) “categorization” of the patient's disease, and b) “explanation” for pathologic phenomena. The diagnostic procedure is usually based above all on categorization. In the first phase of this procedure the clinician searches for data that are of the greatest possible “informative value”, and then goes works out a certain number of “syndromic complexes”. In the second phase, on the basis of these “groups of signs”, the physician must formulate a certain number of diagnostic hypotheses and evaluate the probability of the presence of a particular disease, in view of the presence of particular signs. Finally, two fundamental arguments of clinician are dealt with: “the confirmatory argument” and “the falsifying argument”, and the value of these two inferences in conferring certainty or a certain grade of reliability on clinical judgement is analyzed and discussed.