The relationship between repeat tympanostomy tube insertion and adenoidectomy

Objectives

To examine the relationship between adenoidectomy and repeat tympanostomy tube placement in the treatment of otitis media, and the relationship between potential risk factors for otitis media and repeat tympanostomy tube placement.

Methods

Retrospective, cross-sectional analysis of consecutive patients undergoing tympanostomy tube placement at an academic/teaching hospital with 400+ beds. Utilizing an electronic billing database, patients less than 18 years of age undergoing tympanostomy tube placement between January 1, 2000 and December 31, 2007 were identified. Information regarding initial and repeat tympanostomy tube placement as well as potential risk factors for otitis media were extracted from medical records.

Results

904 children were included in the study. Of the 780 children who initially underwent tympanostomy tube placement alone, 178 required additional tube placement; a repeat rate of 20%. Of the 90 children who initially underwent tympanostomy tube placement with adenoidectomy, only 6 required repeat tube placement, a statistically significant decrease in the incidence of repeat tympanostomy tube placement (95% CI, 0.056–0.334; p < 0.0001). The presence of craniofacial anomalies and day care/school attendance were significantly associated with additional tube placement. Children between the ages of 4 and 10 showed a significant (p < 0.0001) decrease in the risk of repeat tube placement when an adenoidectomy was performed at the initial tube placement.

Conclusion

Adenoidectomy performed at the first tympanostomy tube for the treatment of otitis media may decrease the risk of repeat tube placement, especially for children >4–10 years of age.     

HMB-45抗原在毛囊黑素细胞中的表达

用单克隆抗体ＨＭＢ－４５，以ＡＰＡＡＰ法对２０份头皮活检标本的９８个毛囊组织进行染色。其中２０个毛囊为生长早期，６３个为成熟生长期，７个为退行期和８个是休止期。结果，５２个成熟生长期及２０个生长早期毛囊的黑素细胞与单克隆抗体ＨＭＢ－４５显著结合。所有退行期、休止期及工１１个成熟生长期毛囊未被染色。结果提示；ＨＭＢ－４５在毛囊中的表达随毛发生过周期而变化，且与黑素细胞功能活性状态有关。     

神经传导速度测定对糖尿病合并肘管综合征的诊断意义

目的对糖尿病并发肘管综合征患者的神经传导速度测定结果进行分析。方法对85例糖尿病患者行神经传导速度及肌电图检测,统计糖尿病周围神经损害及肘管综合征的比率。结果 85例患者中周围神经损害36例,符合肘管综合征诊断11例(12.9%),其中糖尿病周围神经损害合并肘管综合征7例,单纯肘管综合征4例,双侧均有损害的3例。肘管综合征表现为肘下-肘上运动神经传导速度减慢(同上臂比较>10m/s),并有腕—小指感觉神经电位波幅降低8例,肘下-肘上运动电位波幅降低(>50%)伴小指展肌、第一骨间肌出现自发电位3例。结论糖尿病患者中并发肘管综合征的患者并不少见,可能存在卡压机制,并且神经传导速度测定可以及早发现糖尿病并发的肘管综合征,使患者能及时得到治疗。     

Rab GTPases as regulators of endocytosis,targets of disease and therapeutic opportunities

Agola JO, Jim PA, Ward HH, BasuRay S, Wandinger‐Ness A. Rab GTPases as regulators of endocytosis, targets of disease and therapeutic opportunities. Rab GTPases are well‐recognized targets in human disease, although are underexplored therapeutically. Elucidation of how mutant or dysregulated Rab GTPases and accessory proteins contribute to organ specific and systemic disease remains an area of intensive study and an essential foundation for effective drug targeting. Mutation of Rab GTPases or associated regulatory proteins causes numerous human genetic diseases. Cancer, neurodegeneration and diabetes represent examples of acquired human diseases resulting from the up‐ or downregulation or aberrant function of Rab GTPases. The broad range of physiologic processes and organ systems affected by altered Rab GTPase activity is based on pivotal roles in responding to cell signaling and metabolic demand through the coordinated regulation of membrane trafficking. The Rab‐regulated processes of cargo sorting, cytoskeletal translocation of vesicles and appropriate fusion with the target membranes control cell metabolism, viability, growth and differentiation. In this review, we focus on Rab GTPase roles in endocytosis to illustrate normal function and the consequences of dysregulation resulting in human disease. Selected examples are designed to illustrate how defects in Rab GTPase cascades alter endocytic trafficking that underlie neurologic, lipid storage, and metabolic bone disorders as well as cancer. Perspectives on potential therapeutic modulation of GTPase activity through small molecule interventions are provided.     

Sulfonamide resistance in isolates of Nocardia spp. from a US multicenter survey

Recent reports of increasing in vitro sulfonamide resistance in Nocardia prompted us to investigate the findings. Despite the reports, there is a paucity of clinical reports of sulfonamide failure in treatment of nocardia disease. We reviewed 552 recent susceptibilities of clinical isolates of Nocardia from six major laboratories in the United States, and only 2% of the isolates were found to have resistant MICs of trimethoprim-sulfamethoxazole and/or sulfamethoxazole. We hypothesize that the discrepancies in the apparent sulfonamide resistance between our study and the previous findings may be associated with difficulty in the laboratory interpretation of in vitro MICs for trimethoprim-sulfamethoxazole and sulfamethoxazole and the lack of quality controls for Nocardia for these agents.     

Rapid infusion of sodium valproate in acutely ill children

The purpose of this study was to investigate the clinical safety of sodium valproate and total and unbound valproic acid plasma concentrations after rapid infusion in hospitalized, acutely ill children. Four children (5-15 years) completed the study. Sodium valproate doses (8.3-15.4 mg/kg) were administered in 相似文献   

Histomorphometric evaluation of delayed changes in masseter muscle after lengthening the rabbit mandible by distraction osteogenesis

Objective:  The aim of the study was to evaluate the delayed responses and changes of gradually lengthened masseter muscles of rabbit mandibles.
Study Design:  Unilateral lengthening of rabbit mandibles was performed in 18 New Zealand rabbits for 7 days at the rate of 1 mm day⁻¹. Mandibles of animals were removed at months 3, 4, and 6 after distraction. Biopsy samples of distracted and contralateral side masseter muscles were histopathologically evaluated and mean area of muscle fibers (MAF) was evaluated with histomorphometric methods. Results were statistically analyzed.
Results:  Mild to moderate atrophy of the fibers, and necrosis and myophagocytosis in some areas were the leading features at month 3 and which were decreased at month 4 in distracted side-muscle specimens, with no statistically significant differences when compared with non-distracted side muscles at the same periods. Almost completely, normal fibers were detected in distracted muscle specimens at month 6. Evidence of myopathic changes was found to disappear at month 6 and no significant difference was found in the MAF of distracted side muscles.
Conclusion:  This study showed that the masseter muscle could adapt to gradual lengthening of the mandible within 6 months. Regenerative features and some degree of atrophic changes that could be observed at months 3 and 4 disappeared at month 6, with adaptation of the fibers.     

中国肝癌肝移植的现状与展望

肝癌行肝移植治疗的指征、效果和相关问题一直存在争论,国际上已经有数个通用的肝癌肝移植标准,如Milan标准、Pittsburgh标准、UCSF标准等等,中国的移植学家们也在纷纷探讨适合中国的肝癌肝移植标准.本文收集并分析近年来国内外的文献,结合本移植中心460例肝移植的病例,对肝癌的分期标准、晚期肝癌行肝移植的指征进行了探讨,笔者认为影响我国肝癌肝移植的主要因素有:供肝的来源、术后乙肝及肿瘤的复发及相关社会因素等.