Chronic encapsulated mediastinal abscess presenting with remote cutaneous fistulization 12 years after redo aortic valve replacement for prosthetic valve endocarditis

Chronic encapsulated mediastinal abscess is an unusual complication of previous open heart surgery. We report on the case of a 79 year old male who presented with epigastric fistulization of an encapsulated anterior mediastinal abscess 12 years after a redo aortic valve replacement for prosthetic valve endocarditis. The encapsulated abscess and its complex branching tracts and the cutaneous fistula were excised completely except the thin longitudinal strip of the ascending aorta which formed part of the posterior wall of the infected tract. This was covered with transposed greater omentum based on right gastroepiploic artery pedicle. Patient remains fit and well 2 years after his operation.     

人原始生殖细胞分离培养的初步研究

[目的]探讨分离培养人原始生殖细胞的最佳条件。[方法]用胰蛋白酶消化5～9周人流组织中的人胚生殖嵴,获取人原始生殖细胞。以小鼠胚胎成纤维细胞作饲养层,在高糖DMEM培养基中添加10μmol/L福司克林(forskolin)和5～μg/L碱性成纤维细胞生长因子(bFGF)的培养液中培养、传代,并对子代细胞进行碱性磷酸酶活性检测和体外分化实验。[结果]原代培养时形成许多大小不等,形态各异的由人原始生殖细胞组成的集落,约5～7d传代。传代后,集落生长,变大。细胞培养到第七代,检测碱性磷酸酶染色为强阳性,体外分化实验有拟胚体形成。[结论]人原始生殖细胞可以用胰蛋白酶消化分离培养。用高糖DMEM培养基,添加forskolin和bFGF有利于人原始生殖细胞增殖。体外分化实验初步证实人原始生殖细胞具有多向分化潜能。     

Casein phosphopeptide‐amorphous calcium phosphate: a remineralizing agent of enamel

The pathogenesis of enamel caries involves a succession of demineralization and remineralization activities. The net effect can result in lesion consolidation when the redeposited minerals improve the resistance of the surface to the extent that the usual level of cariogenic activity cannot cause mineral dissolution. Since it has been established that the caries process is a continuum, albeit one that is interrupted numerous times daily, it is therefore possible to intervene at any stage with a therapeutic product or an intervention methodology. Incorporation of remineralizing treatments into routine dental care programmes will have a strong impact on the public health aspects of caries control. A recent advancement in the phenomenon of remineralization is the casein phosphopeptides. These casein phosphopeptides localize the amorphous calcium phosphate and are proved to be anticariogenic. This review discusses the mechanism of remineralization by casein phosphopeptide‐amorphous calcium phosphate and its incorporation into various products.     

EMLA用于牙体病治疗镇痛效果的临床研究

目的 :临床观察恩钠 (EMLA)用于牙体病牙齿制备时的镇痛效果及对牙齿电活力的影响。方法 :5 0例患者采用自身牙齿配对随机对照分组 ,实验牙齿用EMLA涂抹牙齿及牙周粘膜后 5min测量牙齿电活力 ,用VAS法评价磨切牙齿时疼痛情况。与空白治疗牙齿进行对比。结果 :EMLA处理后牙齿电活力从 4 5 .76± 1.5 6上升至 6 4.34± 2 .2 8,VAS值为 2 .5 4± 0 .84 ,对照组VAS值为 7.4 2± 0 .5 1,两组VAS值有显著性差异 ,P <0 .0 1。结论 :EMLA可提高牙齿电活力 ,在牙体病牙齿治疗过程中有镇痛作用。     

CLIMACTERIC SYMPTOMS IN HEALTHY MIDDLE-AGED WOMEN

SUMMARY The incidence of climacteric symptoms was determined in 247 healthy premenopausal women in a community setting. These volunteers had been recruited to a longitudinal study of bone density. Of these subjects, 46 ceased to menstruate during the study, and in this subgroup symptoms were compared before and after cessation of menstruation. Only hot flushes increased after cessation of menstruation in the longitudinal study and showed age correlation in the cross-sectional study. Hot flushes thus emerged as a true menopausal symptom. Although evidence for this is weaker, cold sweats and suffocation seem likely to be genuinely menopausal. Breast discomfort and the four mood symptoms of irritability, excitability, depression and poor concentration improved after cessation of menstruation, and this study gives no support for their being part of the menopausal syndrome; it suggests that these symptoms are more likely to be related to menstruation than to the menopause.     

电动牙刷与手动牙刷对口腔卫生的效果比较

目的对电动牙刷和手动牙刷在去除菌斑、维护牙龈健康、对色素和牙结石的作用、可靠性、不良作用和成本等进行比较.方法计算机检索Cochrane口腔健康协作组临床试验资料库(截至2004年6月17日)、Cochran临床对照试验中心资料库(Cochrane图书馆2004第2期)、MEDLINE(1966～2004)、EMBASE(1980～2004第2周)和CINAHL(1982～2004第2周),并与制造商联系以获取更多资料.根据下列标准纳入随机对照试验:随机分配研究对象;参加者为手运动无障碍的普通人群;干预措施为无监督的手动或电动牙刷刷牙,至少4周;主要结局指标为试验期间菌斑和牙龈炎的变化.由6个作者独立评价并纳入研究资料.用随机效应模型进行Meta分析,用标准化均数差(SMD)及其95%CI测量效果.检查可能的异质性来源,并针对研究质量和发表偏倚进行敏感性分析.为便于讨论,将SMD转换为百分率.结果对包含3 855例研究对象的42个试验进行系统评价,结果显示,旋转振动型电动牙刷去除菌斑和减低牙龈炎的效果在短期内明显优于手动牙刷,并在3个月以上的研究中显示降低了牙龈炎指数.在1～3个月的研究中,菌斑SMD为-0.43 [95%CI (-0.72, 0.14)],牙龈炎SMD为-0.62 [95%CI (-0.90, 0.34)],Quigley Hein菌斑指数降低11%,Loe and Silness龈炎指数降低6%.在3个月以上的研究中,菌斑指数SMD为-1.29 [95%CI (-2.67, 0.08)], 龈炎指数为-0.51 [95%CI (-1.76, 0.25)],Ainamo Bay探诊出血指数降低17%.短期研究之间有异质性,敏感性分析显示当选择高质量的研究时结果是肯定的,没有证据表明有发表偏倚.采取其他设计的电动牙刷并不比手动牙刷更优.对成本、可靠性和不良作用的报道不一致,已报道的不良作用都是局限的、暂时的.结论旋转振动型电动牙刷去除牙菌斑、减少牙龈炎的效果优于手动牙刷.遵守方法学指南和更标准化的设计有益于将来的研究和Meta分析.     

The association of biologically active lipids with the development of transfusion-related acute lung injury: a retrospective study

BACKGROUND: Transfusion-related acute lung injury (TRALI) is clinically similar to the adult respiratory distress syndrome (ARDS) and has been linked to the transfusion of leukocyte antibodies in blood components. Animal model have implicated neutrophil (PMN)-priming agents in ARDS; however, two agents were required. Previous studies showed the generation of PMN-priming agents during blood storage. Thus the association of PMN-priming agents with TRALI was examined. STUDY DESIGN AND METHODS: Ten patients with TRALI and 10 with febrile or urticarial reactions (control group) were evaluated. The presence of PMN-priming activity was tested in the patients' pretransfusion and posttransfusion blood samples by incubating PMNs with these samples followed by activation of the respiratory burst. Plasma lipids were separated by normal-phase high-performance liquid chromatography (HPLC), and the priming activity was evaluated. The presence of leukocyte antibodies was determined in the blood donors and patients with TRALI. RESULTS: Significantly more PMN-priming activity was present in the posttransfusion sera (11.4 +/? 1.8 nmol superoxide anion/min, mean +/? SEM; n=10) and plasma of patients with TRALI than in their pretransfusion sera (6.5 +/? 1.5: n=10) or in the pretransfusion and posttransfusion sera (5.1 +/? 1.3, n=10; and 4.5 +/? 1.4, n=10, respectively) and from the controls (p < 0.05). HPLC separation of lipids demonstrated that three active species were present in the posttransfusion plasma samples of TRALI patients. All the patients with TRALI had underlying clinical factors, such as infection, cytokine administration, recent surgery, or massive transfusion, while only 2 of 10 control patients had these clinical conditions. None of the donors had significant titers of HLA or HLA-DR antibodies; however, 50 percent had weak positivity for granulocyte antibodies. CONCLUSION: TRALI is the result of two clinical events, the first being a predisposing clinical condition and the second being the transfusion of biologically active lipids in stored blood.     

Whipple's disease without malabsorption: new atypical features

The diagnosis of Whipple's disease in the absence of intestinal involvement is difficult and often overlooked. We describe five patients aged 8-71 years with normal jejunal biopsies and disparate clinical features, previously unrecognized in Whipple's; all were investigated at a single institution over a period of 18 months. Routine histological examination for periodic acid-Schiff (PAS) positive macrophages and polymerase chain reaction (PCR) analysis for Tropheryma whippelii was performed on the small intestine in all patients. PCR analysis was also performed on various tissues including peripheral blood, lymph node, muscle, synovium and spleen in individual patients. Patients 1, 2, 4 and 5 had unusual presenting features not previously associated with Whipple's: intractable immune thrombocytopenic purpura (ITP), juvenile chronic arthritis, isolated muscle weakness and quadriparesis, respectively. Patient 3 presented with pyrexia of unknown origin. All patients had histologically normal small-bowel biopsies with no evidence of PAS positive macrophages. PCR for T. whippelii was positive in all patients in one or more tissues: peripheral blood, intestine, muscle, lymph node and synovium. PAS- positive macrophages were found in 4/5 patients in various sites: lymph node, muscle, spinal cord. Whipple's disease presents with protean clinical features and should be considered in granulomatous disorders of unknown aetiology even in the absence of gastrointestinal involvement.      

汉族与壮族青年人格结构的比较

目的:根据人口比例、地理位置、生产方式、语言文字状况等方面来选择了汉族与壮族民族作为研究的对象,比较汉族与壮族青年的人格结构。方法:于2005-07/2005-09在广州、湛江、东莞、天津、西安、长沙、沈阳、南宁等地进行样本采集。在汉族被试中发放问卷共1370份,在壮族被试中发放问卷共440份。具体操作是:在当地学校开家长会期间,在不同年级中采用整群随机抽样的方法选取某一班级的家长进行团体施测。汉族被试者平均年龄(33.1±0.3)岁,壮族被试者平均年龄(32.2±0.8)岁。选用的量表是中国人人格形容词评定量表(简式)。该量表包括了“外向活跃”、“严谨自制”、“温顺随和”、“热情豪爽”、“淡泊诚信”、“精明干练”、“善良友好”7个分测验,采用6级评分,要求被试对每一个项目做1～6分(即“完全不符合自己的情况”到“完全符合自己的情况”)的评定。分析两个民族与“‘大七’人格结构模型”的拟合度、两个民族人格结构的均值。结果:在汉族被试者中发放问卷共1370份,回收问卷1368份,问卷回收率99.85%。在壮族被试中发放问卷共440份,回收问卷431份,问卷回收率98.0%。根据回答量表的有效情况,筛选汉族有效被试共985名,壮族有效被试共307名。①汉族的人格结构与“大七人格结构模型”拟合良好,而壮族则拟合不良,拟合优度指数分别为0.84,0.62。②壮族在“外向活跃”、“温顺随和”、“热情豪爽”“善良友好”4个人格结构因子上的得分均显著高于汉族(44.70±5.58,43.26±6.78;31.62±4.62,30.39±4.96;31.72±3.98,30.80±4.63;18.92±4.19,18.36±4.04;F=7.91,10.43,6.84,3.16,P<0.01,0.05)。两族在“严谨自制”、“淡泊诚信”、“精明干练”这几个方面没有差异。结论:汉族与壮族因各自生态环境的相似性与差异性而导致了文化形态的异与同,从而导致了两个民族所形成的行为方式的共性与个性,而在本调查中则具体体现为两个民族人格结构的异同。