Managing acrometastases treatment strategy with a case illustration

The hand is the site of a great variety of benign lesions and, rarely, of malignant lesions. Acrometastasis can be the first manifestation of occult malignancy. Frequently, these lesions present in a similar way to benign conditions leading to erroneous diagnosis and inappropriate treatment. When located in the finger, the most frequent cause is lung cancer, while in the toes it is due to genito-urinary tumours. Awareness of the possibility of metastatic disease during orthopaedic assessment is essential to decrease patient morbidity. A case that was referred to our institution with a single metastasis in a digit from occult gastric adenocarcinoma is used to illustrate the way these lesions are managed. The diagnostic difficulties are summarised and an overview of literature was performed to determine management pathways to aid others in the treatment of these case.     

胃重复畸形并胃胰腺损伤1例

1临床资料患儿,女性,4岁。因间断性腹痛1月加重伴黑便15d,呕吐2d入院。患儿病前无明确外伤史,其母于入院前15d发现左膝部有损伤痕,已愈合,行腹部B超检查,提示肝胆肾正常,胰大小正常,边界清,实质回声均匀,主胰管不扩张,肝前区肝肾夹角及脾肾夹角可见53mm的液性暗区,内见肠管蠕动     

动态监测血清相关指标对重型颅脑损伤术后肺部感染的预测价值

目的 分析动态监测重型颅脑损伤术后患者血清降钙素原(PCT)、可溶性髓样细胞表达的激发受体-1(sTREM-1)及C反应蛋白与白蛋白比值(CRP/ALB)的变化对肺部感染的早期预测价值.方法 选取手术治疗的196例重型颅脑损伤患者,监测并记录术后1、3、5d的血清PCT、CRP、ALB、sTREM-1及CRP/ALB水...     

Epidemiologic background and long-term course of disease in human immunodeficiency virus type 1-infected blood donors identified before routine laboratory screening. Transfusion Safety Study Group

BACKGROUND: The long-term course of human immunodeficiency virus type 1 (HIV-1)-related disease among seropositive blood donors has not been described. The enrollment and epidemiologic background of HIV-1- infected donors in the Transfusion Safety Study and their immunologic and clinical progression are described. STUDY DESIGN AND METHODS: Through the testing of approximately 200,000 sera from donations made in late 1984 and early 1985, 146 anti-HIV-1-positive donors and 151 uninfected matched donors were enrolled. These two cohorts were followed with 6-month interval histories and laboratory testing. RESULTS: Seropositive donors detected before the institution of routine anti-HIV-1 screening disproportionately were first-time donors and men with exclusively male sexual contacts. The actuarial probability of a person's developing AIDS within 7 years after donation was 40 percent; the probability of a person's dying of AIDS was 28 percent. AIDS developed more often when the donor was p24 antigen-positive at donation. Over a 3-year period, significant decreases occurred in CD4+, CD2+CD26+, CD4+CD29+, and CD20+CD21+ counts, but not in CD8+ subsets, CD20+, or CD14+. CONCLUSION: The high proportions of first-time donations and exclusively homosexual men among seropositive donors suggest that test-seeking may have contributed to the high HIV-1 prevalence in the repository. Implementation of alternative test sites when routine donor screening began in 1985 may have averted many high- risk donations. The disease course in HIV-1-infected donors had the same wide spectrum of immunologic and clinical manifestations as were reported for other cohorts.     

Prevalence of IgG autoantibody against F-actin in patients suspected of having autoimmune or acute viral hepatitis

Our objectives in this study were to compare results obtained by an enzyme immunoassay (EIA) for F-actin antibody (FAA) immunoglobulin G (IgG) to those determined by an indirect fluorescent antibody (IFA) assay for smooth muscle antibody (SMA) IgG, and to determine the prevalence of FAA in patient sera having serologic evidence of acute viral hepatitis. Sera from 415 patients suspected of having autoimmune hepatitis (AIH), 208 patients suspected of having acute viral hepatitis A, B, or C, and 100 healthy blood donors (HBD) were included in the study. Only one of 100 HBD showed low levels (20-30 Units) of F-actin IgG. In patients suspected of having AIH, the prevalence of FAA increased as SMA titers increased and all sera with SMA titers of >or=1:160 were FAA-positive. In contrast, there were many sera with negative (<1:20) or low (1:20-1:40) SMA titers that contained moderate to high levels (>30 Units) of FAA; many exceeding 80 Units. Moreover, 51.4% of these sera were also positive for anti-nuclear antibody (ANA), which is also utilized in diagnosing type 1 AIH. FAA was detected in 25% of viral hepatitis antibody-positive sera, with the majority (59.3%) containing low levels, and all were ANA-negative.     

新疆护理专职教师工作压力现状及影响因素

目的探讨新疆护理教师工作压力现状并分析其影响因素,为提出护理教师队伍建设的相关对策提供实证依据并为护理院校管理和教师人才队伍的可持续发展提出建议。方法采用高职教师工作压力量表对新疆15个地、市、州抽取的10所护理院校在编在岗的256位护理教师进行问卷调查,调查其工作压力现状并分析其影响因素。结果护理专职教师的工作压力得分为（2．436±0．576）分,大于2分,说明教师的工作压力大。教龄、婚姻、兼职情况及教学工作量不同的教师因社会因素而产生的工作压力水平不同,不同婚姻状况的教师因学校管理及制度因素产生的压力水平不同,性别、年龄、学历、婚姻、教学工作量不同的教师个人职业发展所带来的压力水平不同,性别、教龄、每周课时量等在护理院校教师工作压力不同;年龄、婚姻状况、教学工作量不同的教师因人际关系产生的工作压力水平不同,性别、年龄、教龄、职称、婚姻、教学工作量、收入水平及兼职情况不同的教师因工作负荷压力水平不同,性别、职称、婚姻、教学工作量、担任教学课程不同的教师因个人特质因素带来的工作压力不同,差异均有统计学意义（P〈0．05）。结论护理专职教师的工作压力大,来源是多方面的,学校管理制度和社会因素带来的压力最大,因此应尽快改变社会各界对护理教育认识上的不足和偏见,明确护理教育的定位,加大国家对护理教育的投入,同时护理教师应提高对自己职业的认识,合理制定自己的职业生涯发展规划。     

Glucose-6-phosphate dehydrogenase variants: reexamination of G6PD Chicago and Cornell and a new variant (G6PD Pea Ridge) resembling G6PD Chicago

Two large and unrelated families were investigated for hereditary nonspherocytic hemolytic anemia associated with deficiency of erythrocyte glucose-6-phosphate dehydrogenase (G6PD). In both families, the kinetic and electrophoretic features of the G6PD variants resembled those of G6PD Chicago. Further investigation revealed that members of one of these families previously had been characterized as having the G6PD variants Chicago and Cornell. However, it is clear that each of these terms has been applied to the same variant in this single large kindred. In the second family, we describe a newly identified variant with unique characteristics, which we have designated G6PD Pea Ridge. G6PD Pea Ridge resembles G6PD Chicago but differs in electrophoretic mobility and in a few kinetic parameters. It exhibits an unusually high Ki for NADPH and thus appears to be insensitive to product inhibition. As other cases previously considered to be the Chicago variant become more fully characterized, this probably will be shown to be a heterogeneous group of variants.     

Performance characteristics of a polyclonal enzyme immunoassay for the quantitation of Histoplasma antigen in human urine samples

An antigen detection assay was prepared with rabbit anti- Histoplasma antibodies to detect and quantitate Histoplasma capsulatum antigen in urine samples. By using a 4-parameter curve fit, the assay calibration ranges from 2 to 1,000 enzyme immunoassay (EIA) units. We compared results for 99 urine samples with those of a reference laboratory, half of which tested positive or equivocal by that reference laboratory. Performance characteristics were further defined by studying the assay linearity, precision, percentage of positive agreement, and percentage of negative agreement. An acceptable correlation with the reference laboratory (R2=0.7174) was obtained with results ranging from less than 2 (negative samples) to 132 EIA units by the new method. Compared with the reference laboratory, the percentage of agreement for positive samples, excluding equivocal samples, was 92% and for negative samples was 98%. Crossreactivity occurred with culture filtrates of Paracoccidioides brasiliensis, Coccidioides immitis, and Blastomyces dermatiditis. No cross-reactivity was observed with Candida albicans or Aspergillus fumigatus culture filtrates. The current EIA for the detection and quantitation of H capsulatum antigen in urine specimens is a valid assay that agrees well with results from an established reference laboratory.