不同氮量全胃肠外营养支持对脓毒症病人蛋白质代谢的影响

如何提高脓毒症闰人营养支持的效果是当前的热点和难点之一。本实验前瞻性地对比观察了不同蛋白质供应负荷０．２５ｇ／Ｖ（ｋｇ．ｄ）ｖｓ０．３５ｇＮ／（ｋｇ．ｄ），在脓毒症病人全有肠外营养支持中对蛋白质代谢状况的影响。结果发现，与低氮量ＴＰＮ相比，高氮量ＴＰＮ支持可改善血浆蛋白水平，增加累积氮平衡，但尿中３－ＭＨ排出量也有相应增加。     

Metallic stenting of the biliary tree following liver transplant hepatic artery thrombosis in an infant

We report the placement of intrahepatic metallic, balloon-expandable stents in the biliary tree following liver transplantation in a 12-month-old infant who developed biliary strictures secondary to hepatic artery thrombosis. The use of such stents has not previously been reported following transplantation in an infant. Re-transplantation was undertaken 5 months after stenting because of chronic rejection and progressive obstructive jaundice. Received: 19 February 1996 Accepted: 26 February 1996     

Haemophilus aphrophilus bleb infection after a mitomycin trabeculectomy

Background: Haemophilus aphrophilus is a rare cause of ocular infection. It has been reported once as a cause of late-onset endophthalmitis in a patient with an inadvertent bleb after cataract surgery. We present a case of Haemophilus aphrophilus bleb infection after a mitomycin trabeculectomy.
Methods: A 56-year-old woman presented with a bleb infection 10 weeks after a mitomycin C augmented trabeculectomy at a University tertiary referral practice of one of the authors (GET). The causative organism was Haemophilus aphrophilus , identified by the Toronto Public Health Laboratory, Ontario, Canada.
Results: The bleb infection resolved following topical, subconjunctival and intravenous antibiotic therapy. A formal bleb revision was required to repair a persistent bleb leak.
Conclusion: Patients who have had trabeculectomies augmented with mitomycin C may be predisposed to bleb infection with unusual organisms. Prompt diagnosis and treatment is necessary to control the infection. Increased awareness and communication with laboratory personnel may increase the isolation of this fastidious organism.     

Umbilical cord ulceration in association with intestinal atresia in a child with deletion 13q and Hirschsprung's disease.

The case is reported of a baby boy with an interstitial deletion of the long arm of chromosome 13 who, in addition to the described associations of Hirschsprung's disease and intestinal atresia, had umbilical cord ulceration resulting in massive intrapartum haemorrhage. This case provides support for the existence of a previously reported association between umbilical cord ulceration and intestinal atresia, and suggests that it is aetiologically heterogeneous.     

人亲环素A基因克隆及在大肠杆菌中表达

目的 :用基因重组技术表达人亲环素 A( Cy PA) ,以避免从人组织材料中提取纯化该蛋白的麻烦。　 方法 :应用反转录聚合酶链反应 ( RT- PCR)技术从人淋巴细胞系 ( MT4 )总 RNA中扩增得到 Cy PA基因片段 ,并用重组 DNA技术对该基因片段进行克隆 ,构建表达载体 ,转入大肠杆菌进行表达。　 结果 :DNA序列分析表明 ,得到的基因片段与设计编码 Cy PA的结构基因序列完全相同。所构建的表达载体 p ET11/Cy PA转入大肠杆菌获得表达 ,重组蛋白表达量占菌体可溶性蛋白的 4 1% ,经测定具有肽基脯氨酸顺 /反异构酶活性。　 结论 :利用基因重组技术使大肠杆菌高效表达出有生物活性的人 Cy PA。     

MRI of late microstructural and metabolic alterations in radiation‐induced brain injuries

Purpose

To evaluate the late effects of radiation‐induced damages in the rat brain by means of in vivo multiparametric MRI.

Materials and Methods

The right hemibrains of seven Sprague‐Dawley rats were irradiated with a highly collimated 6 MV photon beam at a single dose of approximately 28 Gy. Diffusion tensor imaging (DTI), proton MR spectroscopy (¹H‐MRS), T2‐weighted imaging, and T1‐weighted imaging were performed to the same animals 12 months after radiation treatment.

Results

Compared with the contralateral side, a significantly higher percentage decrease in fractional anisotropy was observed in the ipsilateral fimbria of hippocampus (29%) than the external capsule (8%) in DTI, indicating the selective vulnerability of fimbria to radiation treatment. Furthermore, in ¹H‐MRS, significantly higher choline, glutamate, lactate, and taurine peaks by 24%, 25%, 87%, and 58%, respectively, were observed relative to creatine in the ipsilateral brain. Postmortem histology confirmed these white matter degradations as well as glial fibrillary acidic protein and glutamine synthetase immunoreactivity increase in the ipsilateral brain.

Conclusion

The microstructural and metabolic changes in late radiation‐induced brain injuries were documented in vivo. These multiparametric MRI measurements may help understand the white matter changes and neurotoxicity upon radiation treatment in a single setting. J. Magn. Reson. Imaging 2009;29:1013–1020. © 2009 Wiley‐Liss, Inc.     

Is there a GP in the hospital?

Modern health care is increasingly complex with a progression to specialisation and super specialisation in the primary and tertiary settings. Traditional models of health such as the biomedical model are often inadequate. The value of a more holistic approach to patients' health problems has been long accepted by the medical profession. As health care becomes more fragmented we are overlooking the potential benefits of a generalist approach in improving the care of patients in our hospitals. This article examines the potential benefits of involving general practitioners in the tertiary care setting.     

An empirical evaluation of the performance of antibody identification tasks

Four empirical studies were conducted for better understanding of the nature of problem-solving activities by medical technologists and medical technology students when performing antibody identification tasks. The results indicated the importance of strategies that ensure the collection of converging evidence, as these strategies protect against the fallibility of commonly used heuristics and against errors due to simple slips. The results also indicate that not only do students make significant numbers of errors, but so do practicing technologists. In one of the studies covering a 1-year period, for instance, a group of 16 technologists made a total of 41 errors in 1057 cases. On the basis of these findings, several alternatives are proposed to reduce errors.