Thyroid structure and function in bovine β-mannosidosis

Summary In bovine -mannosidosis, the thyroid in the affected newborn shows marked cytoplasmic vacuolation. There is an associated reduction in the serum concentrations of thyroxine and tri-iodothyronine.     

Sensorless flow and head estimation in the VentrAssist rotary blood pump

Flow rate and pressure difference (or head) are key variables needed in the control of implantable rotary blood pumps. However, use of flow and/or pressure probes can decrease reliability and increase system power consumption and expense. For a given fluid viscosity, the flow state is determined by any 2 of the 4 pump variables: Flow, pressure difference, speed, and motor input power can be used. Thus, if viscosity is known or if its influence is sufficiently small, flow rate and pressure difference can be estimated from the motor speed and motor input power. For the VentrAssist centrifugal blood pump, which uses a hydrodynamic bearing, sensorless flow and pressure head estimation accuracy of 2 of our impeller designs were compared for a viscosity range of 1.2 to 4.5 mPas. This showed impeller design optimization can improve estimation accuracy. We also compared estimation accuracy using 2 blood analogues used in vitro, aqueous glycerol and red blood cells suspended in Haemaccel. The nature of the blood analogue and not only the viscosity of the fluid seems to influence estimation accuracy in our pump.     

Extracellular truncations of h beta c, the common signaling subunit for interleukin-3 (IL-3), granulocyte-macrophage colony-stimulating factor (GM-CSF), and IL-5, lead to ligand-independent activation

The hypothesis that extracellular truncation of the common receptor subunit for interleukin-3 (IL-3), granulocyte-macrophage colony- stimulating factor, and IL-5 (h beta c) can lead to ligand-independent activation was tested by infecting factor-dependent hematopoietic cell lines with retroviruses encoding truncated forms of h beta c. A truncation, resembling that in v-Mpl, and retaining 45 h beta c-derived extracellular residues, led to constitutive activation in the murine myeloid cell line, FDC-P1. However, infection of cells with retrovirus encoding a more severely truncated receptor, retaining only 7 h beta c- derived extracellular residues, did not confer factor independence on these cells. These experiments show that truncation activates the receptor and define a 37-amino acid segment of h beta c (H395-A431) which contains two motifs conserved throughout the cytokine receptor superfamily (consensus Y/H XX R/Q VR and WSXWS), as essential for factor-independent signaling. The mechanism of activation was also investigated in less severe truncations. A receptor that retains the entire membrane-proximal domain (domain 4) also conferred factor independent growth on FDC-P1 cells; however, a retrovirus encoding a truncated form of h beta c having two intact membrane proximal domains did not have this ability, suggesting that domain 3 may have an inhibitory role in h beta c. The ability of these receptors to confer factor independence was cell specific as demonstrated by their inability to confer factor-independent growth when introduced into the murine IL-3-dependent pro-B cell line BaF-B03. These results are consistent with a model in which activation requires unmasking of an interactive receptor surface in domain 4 and association with a myeloid- specific receptor or accessory component. We suggest that in the absence of ligand intramolecular interactions prevent inappropriate signaling.     

Management of mild to moderate aortic valve disease during coronary artery bypass grafting.

OBJECTIVE: The long term survival of patients with mild to moderate aortic valve disease who do not have valve replacement at the time of coronary artery bypass grafting (CABG) is unknown. Therefore we have reviewed our experience with such patients. METHODS: We reviewed the medical records of consecutive patients between June 1978 and December 1996, and identified 40 patients with mild to moderate aortic valve disease, who underwent CABG, without valve replacement (study group). Mean preoperative aortic gradient was 34 mmHg and mean intraoperative gradient 20 mmHg. Eleven patients underwent valve inspection, and an equal number, underwent valve repair. The records of 61 other patients with severe aortic valve disease, who underwent concomitant aortic valve replacement (AVR) and CABG (control group), were also reviewed. RESULTS: Survival was significantly better in the control group. Eleven patients (27.5%) in the study group underwent reoperation for AVR, with no operative mortality. Multivariate analysis confirmed valve replacement at initial CABG to be the only predictor of survival (beta=0.586,P=0.038) Preoperative gradient <40 mmHg, intraoperative gradient <20 mmHg, age over 70, sex, aortic stenosis and valve pathology did not predict survival in the study group. CONCLUSION: Patients with mild to moderate aortic valve disease undergoing coronary artery bypass grafting may be best served by valve replacement, rather than repair, inspection or no procedure.     

高压氧综合治疗糖尿病足的临床疗效观察

糖尿病足(diabetic foot,DF)是常见的糖尿病慢性合并症之一,也是导致糖尿病人截肢致残的主要原因.近年来,糖尿病患病率逐年增高,使糖尿病足的患病率也呈逐年上升的趋势.     

Collaborative care for depression in UK primary care: a randomized controlled trial

BACKGROUND: Collaborative care is an effective intervention for depression which includes both organizational and patient-level intervention components. The effect in the UK is unknown, as is whether cluster- or patient-randomization would be the most appropriate design for a Phase III clinical trial. METHOD: We undertook a Phase II patient-level randomized controlled trial in primary care, nested within a cluster-randomized trial. Depressed participants were randomized to 'collaborative care' - case manager-coordinated medication support and brief psychological treatment, enhanced specialist and GP communication - or a usual care control. The primary outcome was symptoms of depression (PHQ-9). RESULTS: We recruited 114 participants, 41 to the intervention group, 38 to the patient randomized control group and 35 to the cluster-randomized control group. For the intervention compared to the cluster control the PHQ-9 effect size was 0.63 (95% CI 0.18-1.07). There was evidence of substantial contamination between intervention and patient-randomized control participants with less difference between the intervention group and patient-randomized control group (-2.99, 95% CI -7.56 to 1.58, p=0.186) than between the intervention and cluster-randomized control group (-4.64, 95% CI -7.93 to -1.35, p=0.008). The intra-class correlation coefficient for our primary outcome was 0.06 (95% CI 0.00-0.32). CONCLUSIONS: Collaborative care is a potentially powerful organizational intervention for improving depression treatment in UK primary care, the effect of which is probably partly mediated through the organizational aspects of the intervention. A large Phase III cluster-randomized trial is required to provide the most methodologically accurate test of these initial encouraging findings.