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21.
There is controversy regarding the nature and degree of intellectual and memory deficits in chronic Lyme disease. In this study, 81 participants with rigorously diagnosed chronic Lyme disease were administered the newest revisions of the Wechsler Adult Intelligence Scale (WAIS-III) and Wechsler Memory Scale (WMS-III), and compared to 39 nonpatients. On the WAIS-III, Lyme disease participants had poorer Full Scale and Performance IQ's. At the subtest level, differences were restricted to Information and the Processing Speed subtests. On the WMS-III, Lyme disease participants performed more poorly on Auditory Immediate, Immediate, Auditory Delayed, Auditory Recognition Delayed, and General Memory indices. Among WMS-III subtests, however, differences were restricted to Logical Memory (immediate and delayed) and Family Pictures (delayed only), a Visual Memory subtest. Discriminant analyses suggest deficits in chronic Lyme are best characterized as a combination of memory difficulty and diminished processing speed. Deficits were modest, between one-third and two-thirds of a standard deviation, consistent with earlier studies. Depression severity had a weak relationship to processing speed, but little other association to test performance. Deficits in chronic Lyme disease are consistent with a subtle neuropathological process affecting multiple performance tasks, although further work is needed to definitively rule out nonspecific illness effects.  相似文献   
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Although aneurysm size still remains the most accepted predictor of rupture risk, abdominal aortic aneurysms (AAAs) with maximum diameter smaller than 5 cm may also rupture. Growth rate is an additional marker for rupture risk as it potentially reflects an undesirable wall remodeling that leads to fast regional growth. Currently, an indication for surgery is an expansion rate >10 mm/year, measured as change in maximum diameter over time. However, as AAA expansion is non-uniform, it is questionable whether measurement of maximum diameter change over time can capture increased localized remodeling activity. A method for estimating AAA surface area growth is introduced, providing a better measure of local wall deformation. The proposed approach is based on the non-rigid iterative closest point algorithm. Optimization and validation is performed using 12 patient-specific AAA geometries artificially deformed to produce a target surface with known nodal displacements. Mesh density sensitivity, range of uncertainty, and method limitations are discussed. Application to ten AAA patient-specific follow-ups suggested that maximum diameter growth does not correlate strongly with the maximum surface growth (R 2 = 0.614), which is not always colocated with maximum diameter, or uniformly distributed. Surface growth quantification could reinforce the quality of aneurysm surveillance programs.  相似文献   
24.
The emergence of ganciclovir (GCV) resistance during the treatment of human cytomegalovirus (HCMV) infection is a serious clinical challenge, and is associated with high morbidity and mortality. In this case report, we describe the emergence of two consecutive mutations (A594V and L595W) related to GCV resistance in a patient with HCMV retinitis and long-term HIV progression after approximately 240 days of GCV use. Following the diagnosis of retinitis, the introduction of GCV did not result in viral load reduction. The detected mutations appeared late in the treatment, and we propose that other factors (high initial HCMV load, previous GCV exposure, low CD4+ cell count), in addition to the presence of resistance mutations, may have contributed to the treatment failure of HCMV infection in this patient.  相似文献   
25.

Introduction

We have prospectively compared simulated-difficult tracheal intubation characteristics of four glottiscopes: Airtraq™, GlideScope™, McGrath™, LMA CTrach™ with that of the conventional Macintosh laryngoscope.

Study design

prospective with the airway devices proposed in a randomly assigned order.

Materials and method

Forty-two physicians, naïve to glottiscope handling accepted participating this study after the learning curve of each airway device was completed. Participants were requested to perform two series of five tracheal intubations on the manikin Airman™, the first in standard situation and the second in difficult tracheal intubation simulation. The airway devices were chosen in a randomly assigned order. For each airway tool, the following tracheal intubation characteristics were recorded: laryngeal exposure quality, tracheal intubation and apnea durations. A performance index was calculated and a tracheal intubation difficulty was measured during simulation.

Results

More than 1600 supervised tracheal intubations were performed, including 1000 for the learning process of the glottiscopes, which was completed after 10 uses on the manikin. During standard situation, laryngeal exposure quality was similar with the five airway devices. As compared to the Macintosh laryngoscope, GlideScope™, McGrath™, tracheal intubation duration was shorter (p < 0.05) with the Airtraq™ and longer (p < 0.01) with the LMA CTrach™. During difficult tracheal intubation simulation, laryngeal exposure and tracheal intubation duration was of better quality and shorter with the four glottiscopes as compared to that of LM, respectively. Performance index during difficult tracheal intubation simulation simulation was significantly more important (p < 0.01) with the Airtraq™ and the LMA CTrach™. Airtraq™ and Macintosh laryngoscope were respectively the simplest (p < 0.01) and the most difficult (p < 0.01) airway devices to manage a simulated difficult tracheal intubation.

Conclusion

When difficult airway was simulated on the manikin, the four glottiscopes were superior to the Macintosh laryngoscope to improve laryngeal exposure quality and to reduce duration of tracheal intubation. Airtraq™ and the LMA CTrach™ both demonstrated remarkable advantage over GlideScope™ and McGrath™ for simulated difficult intubation management.  相似文献   
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The process of transplantation of tissues and organs, as a highly specialized treatment method, has a unique place in the field of medical science and practice. On occasion of the 40 anniversary of the first renal transplantation in adult in Bulgaria, the developments in this area are reviewed chronologically. The initial experiments on test animals, as well as the first renal transplantation in adult are described in details. For the abovementioned period 435 renal transplantations have been performed in UMHAT "Alexandrovska", 231 (53.2%) form living kidney donor and 204 (46.9%)--from cadaveric renal donors. The benefits of the existing organization of transplantation in UMHAT "Alexandrovska" are outlined, as well as the problems preventing the transplantation process to achieve even wider usage as a method for treatment of end-stage organ diseases.  相似文献   
29.
BACKGROUND: Paralysis of the vocal cords is one objective of using relaxants to facilitate tracheal intubation. This study compares the neuromuscular blocking effect of succinylcholine and rocuronium on the larynx, the diaphragm, and the adductor pollicis muscle. METHODS: Electromyographic response was used to compare the neuromuscular blocking effect of succinylcholine and rocuronium on the laryngeal adductor muscles, the diaphragm, and the adductor pollicis muscle. Sixteen patients undergoing elective surgery were anesthetized with propofol and fentanyl, and their tracheas were intubated without neuromuscular blocking agents. The recurrent laryngeal and phrenic nerves were stimulated at the neck. The electromyographic response was recorded from electrodes placed on the endotracheal tube and intercostally before and after administration of 1 mg/kg succinylcholine or 0.6 mg/kg rocuronium. RESULTS: The maximum effect was greater at the adductor pollicis (100 and 99%) than at the larynx (96 and 97%) and the diaphragm (94 and 96%) after administration of succinylcholine and rocuronium, respectively (P < or = 0.05). Onset time was not different between the larynx (58+/-10 s), the diaphragm (57+/-8 s), and the adductor pollicis (54+/-13 s), after succinylcholine (all mean +/- SD). After rocuronium, onset time was 124+/-39 s at the larynx, 130+/-44 s at the diaphragm, and 115+/-21 s at the adductor pollicis. After succinylcholine administration, time to 90% recovery was 8.3+/-3.2, 7.2+/-3.5, and 9.1+/-3.0 min at the larynx, the diaphragm, and the adductor pollicis, respectively. Time to 90% recovery after rocuronium administration was 34.9+/-7.6, 30.4+/-4.2, and 49.1+/-11.4 min at the larynx, the diaphragm, and the adductor pollicis, respectively. CONCLUSION: Neuromuscular blocking effect of muscle relaxants on the larynx can be measured noninvasively by electromyography. Although the larynx appears to be resistant to muscle relaxants, we could not demonstrate that its onset time differed from that of peripheral muscles.  相似文献   
30.
In the present study a series of trimetazidine (1-(2,3,4-trimethoxybenzyl)piperazine, CAS 5011-34-7) derivatives is subjected to quantitative structure-activity relationship (QSAR) analysis aiming at establishing the relationship between molecular structure and the binding affinity of the compounds to the respective receptor sites in the cells. Trimetazidine is used in the therapy of ischaemic heart disease. Literature data for the biological effect of the compounds are used. The derivatives studied include compounds with different substituents at the fourth position of the piperazine ring and a variation between the ortho-methoxy and ortho-hydroxy group in the benzyl residue. A statistically significant correlation between the Van der Waals volume of the substituents and the binding affinity of the respective compounds was found.  相似文献   
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