Talcum powder in revision surgery for olecranon bursitis: Good outcome in 11 patients

We adapted the use of talcum powder in chest surgery to create a reactive pleuritis for treating recurrent olecranon bursitis. The 11 patients who underwent this procedure all had favorable outcomes.     

Three methods for minimally important difference: no relationship was found with the net proportion of patients improving

OBJECTIVE: To determine the impact on a responder type analysis of using three published methods to obtain the minimally important difference (MID) on the conclusion of a randomized controlled trial (RCT). STUDY DESIGN AND SETTING: Using data from an RCT of supportive-expressive group therapy (SEGT-intervention) vs. standard care (control) in women with metastatic breast cancer, we measured individual responsiveness to change according to three levels of predefined MID (0.2 SD, 0.5 SD, and 1 standard error of measurement) of the following six validated questionnaires: Profile of Mood States, Impact of Event Scale, Psychosocial Adjustment to Illness Scale, EORTC Quality-of-Life Questionnaire Core-30, Mental Adjustment to Cancer, and a pain visual analog scale. The proportion of women improved by SEGT and the number needed to treat according to three levels of MID were calculated. RESULTS: There was no consistent difference in the net proportion of women improving with the SEGT vs. control arm according to the three different levels of MID. CONCLUSION: The choice between different levels of distribution-based MID did not make an important difference in the net proportion of women improving with the SEGT. Future research should compare MID derived from clinical anchors, in particular patient opinions.     

Apical localization of pulmonary tuberculosis, chronic pulmonary histoplasmosis, and progressive massive fibrosis of the lung

We have reviewed the accumulated evidence for the explanation of the apical localization of pulmonary tuberculosis, chronic pulmonary histoplasmosis, and massive fibrosis of the lung due to silicosis and coal-workers pneumoconiosis. The effect of gravity on the erect human lung results in greatly diminished pulmonary artery blood flow in the apical and subapical areas. This in turn results in higher oxygen tensions but also impairment of tissue clearance mechanisms in these areas. Analysis of the accumulated evidence better supports the theory of lymph stasis and impaired clearance of antigenic substances as the major determinant of the apical localization of pulmonary tuberculosis rather than the presently favored oxygen tension theory. The impaired clearance theory also best explains the apical localization of chronic pulmonary histoplasmosis and progressive massive fibrosis of the lung.     

Sodium-potassium-activated adenosine triphosphatase of brain microsomes: modification of sodium inhibition by diphenylhydantoins

Effects of diphenylhydantoins on (Na(+) + K(+))-ATPase activity in rat and cat brain microsomes were studied. 5,5-diphenylhydantoin (DPH) in concentrations of 5-20 mug ml(-1) produces an apparent stimulation of the rat brain (Na(+) + K(+))-activated ATPase of 55-65% in media containing 50 mM Na(+), 0.15 mM K(+), 3 mM Mg(++), and 3 mM ATP. No effects are found on the Mg-ATPase. At constant K(+) levels of 0.05 mmole/liter and 0.15 mmole/liter, increasing the Na(+) concentration activates the enzyme similarly with and without DPH. However, Na(+) concentrations greater than 5 mmoles/liter and 10 mmoles/liter, respectively, which are inhibitory in these low K(+) media, produce less inhibition in the presence of DPH. In media containing 10 mM Na(+), the K(+) activation, on the other hand, is potentiated by DPH. In preparations from cat brain qualitatively similar results are obtained. No effect of DPH is seen on the inhibition produced by high K(+) in low Na(+) media. DPH produces an approximately constant apparent stimulation of 45% in the (Na(+) + K(+)) increments when these ions are varied simultaneously at a fixed ratio of 150 Na(+):1 K(+) with cat brain extracts. 5-(p-hydroxyphenyl)-5-phenylhydantoin (HPPH) has the same potency as DPH in reducing the Na(+) inhibition at high Na:K ratios. The hydantoins appear to act by decreasing the Na(+) inhibition that occurs at high Na:K ratios.     

Anti-tau scFvs Targeted to the Cytoplasm or Secretory Pathway Variably Modify Pathology and Neurodegenerative Phenotypes

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Acute normovolemic hemodilution is a cost-effective alternative to preoperative autologous blood donation by patients undergoing radical retropubic prostatectomy

BACKGROUND: Preoperative autologous blood donation is accepted as a standard of care for radical prostatectomy. Acute normovolemic hemodilution (ANH) is an alternative method for obtaining autologous blood. The cost and benefits of these two autologous blood-collection techniques are compared. STUDY DESIGN AND METHODS: Thirty consecutive patients scheduled for radical prostatectomy underwent ANH to a target hematocrit level of 28 percent. Blood was transfused in the perioperative period to maintain the hematocrit level > 25 percent. Hematocrit levels, transfusion outcomes and costs, and postoperative outcomes for these patients (hemodilution group) were compared with a matched patient cohort who preoperatively donated 3 units of blood for autologous use in prostatectomy surgery (nonhemodilution group, n = 30). RESULTS: Thirty patients underwent ANH to a hematocrit level of 28.7 +/− 1.7 percent, and 1740 +/− 346 mL (3.5 +/− 0.7 units) of blood were collected. Three (10%) of the patients in each cohort had allogeneic blood exposure. Transfusion costs were 73 percent higher for the nonhemodilution group patients than for the hemodilution group patients ($330 +/− $100 vs. $191 +/− $55, p < 0.001). No differences were found in postoperative outcomes. CONCLUSION: An integrated blood conservation program utilizing hemodilution and a defined transfusion trigger can decrease the requirement for preoperative donation of blood for autologous use in radical prostatectomy. Point-of-care autologous blood procurement is more cost-effective than preadmission donation of autologous blood units.     

肾包膜内注射骨髓间充质干细胞在链脲佐菌素糖尿病模型大鼠体内的定位及功能测评

目的:观察骨髓间充质干细胞在体外不诱导条件下,移植于链脲佐菌素所致糖尿病大鼠后在胰腺的定位及胰岛素分泌情况。方法:实验于2004-08/2006-03在2级实验室唐山工人医院中心实验室和具有国家认证的屏障动物环境实验室华北煤炭医学院动物中心完成。①实验材料:青年清洁级SD大鼠购自华北煤炭医学院动物中心(SCXK2002-0003),4周龄,体质量180～250g,动物级别:SPF/VAF。②实验方法:体外培养雄性SD大鼠骨髓间充质干细胞,并采用流式细胞仪鉴定。选取雌性SD大鼠,按65mg/kg剂量腹腔注射链脲佐菌素建立糖尿病大鼠模型。给药后二三天,大鼠血糖升高,当血糖≥16.7mmol/L且稳定2d,认为糖尿病模型建立成功。将建模成功的40只大鼠完全随机分为对照组、实验组,每组20只。对照组大鼠右侧肾包囊注射磷酸缓冲液0.2mL,实验组大鼠右侧肾包囊下注射骨髓间充质干细胞0.2mL,细胞数为4×105L-1。于移植前及移植后第3,5,7天采大鼠尾静脉血检测血糖。③实验评估:于移植前及注射后7d采大鼠心脏血检测C-肽值,移植后7d取大鼠胰腺组织作石蜡切片,应用原位杂交技术检测Y染色体细胞。结果:40只大鼠全进入结果分析。①骨髓间充质干细胞鉴定:骨髓间充质干细胞呈梭形、放射状,形成数个细胞克隆时排列整齐,原代培养7～10d即可长满,按1∶3传代,生长四五天达融合。流式细胞术表面标志鉴定显示,培养的原代骨髓间充质干细胞表面标志CD90阳性,基质细胞表面标志CD44阳性,造血细胞表面标志CD45及内皮细胞表面标志CD31阴性。②大鼠尾静脉血血糖值、心脏血C-肽值分析:血糖结果显示,对照组治疗后第3,5,7天血糖值及C-肽值与治疗前相比,无明显变化(P>0.05);实验组治疗后第3,5,7天血糖值较治疗前明显下降,治疗后第7天C-肽值明显上升,与对照组对应时间比较,差异均显著[实验组治疗前:(21.75±2.44)mmol/L,(0.21±0.01)μg/L;实验组治疗后:(12.23±1.95)mmol/L,(14.00±2.85)mmol/L,(12.75±2.86)mmol/L,(0.26±0.01)μg/L;对照组治疗后:(21.63±1.34)mmol/L,(23.03±1.11)mmol/L,(22.48±1.92)mmol/L,(0.21±0.01)μg/L,P均<0.01]。③原位杂交技术检测Y染色体细胞:对照组大鼠胰腺组织切片中未见黄绿荧光Y染色体,实验组大鼠胰腺组织切片中可见黄绿荧光Y染色体,存在于胰腺腺泡间隙,或胰腺组织中。结论:雄性大鼠骨髓间充质干细胞在肾包囊注射下可到达雌性糖尿病大鼠胰腺组织,使糖尿病大鼠血糖下降,C-肽值升高,具有分化为胰岛素分泌细胞的可能性。