Pure thoracolumbar facet dislocation: clinical features and CT appearance

The use of computed tomography (CT) in demonstrating pure dislocations of the thoracolumbar facets and in predicting the prognosis of this injury was evaluated and compared with radiography retrospectively. The records of 29 patients with pure thoracolumbar bilateral facet dislocation who were admitted to the trauma unit over a 4-year period were reviewed. Twenty-two patients (76%) had a complete neurologic loss that remained complete following immediate surgical stabilization; five (17%) had an incomplete neurologic loss, and two (7%) were normal neurologically. Plain radiographs of the spine, including anteroposterior and lateral views, documented the level and type of fracture but failed to depict the full extent of bony ad soft-tissue injuries. CT provided essential additional information, particularly regarding the status of the posterior elements of the vertebrae and the adequacy of the spinal canal. Pure thoracolumbar facet dislocations have a characteristic appearance on axial CT scans. Sagittal reformation through CT is essential in the evaluation of this type of spinal injury.     

自体输血指南

1 自体输血规程 预贮式自体献血(PABD,PAD)是指采用类似于从健康无偿献血者采集和保存血液的方法来采集和保存血液,但血液的被采集者同时也是血液的受者,整个过程通过有计划的采集一定量的血液而使患者受益,如择期心外科手术.血液"要求保存在4℃、CPDA1保养液中不超过35天或在优化保存液中不超过42天".本指南介绍了许多实际操作方面的内容,包括:获取转诊信件;征询取得同意;血袋贴标签.     

Surveillance for human immunodeficiency virus type 1 group O infections in the United States

BACKGROUND: Reports that the human immunodeficiency virus type 1 (HIV- 1) group O variants are not reliably detected by some commercial diagnostic tests have raised concerns about the sensitivity of existing screening tests, especially with regard to blood safety. Although it is unlikely that these divergent strains are prevalent in North America, systematic, continuous surveillance is needed to monitor the potential spread of HIV variants into that region. STUDY DESIGN AND METHODS: Stored serum samples (n = 1072) from both high- and low-risk population groups at several sites in the United States and Puerto Rico were tested by peptide enzyme immunoassays specific for the prototypic HIV-1 group O strains, MVP5180 and ANT70. RESULTS: None of the 1072 samples examined had peptide reactivity that was consistent with HIV-1 group O infection. CONCLUSION: While no evidence of specific HIV-1 group O (MVP5180 or ANT70) infection was found in this study, the sensitivity of current tests has not been fully evaluated against the wide range of genetic variation of HIV. Therefore, it is important to continue active surveillance for HIV-1 and HIV type 2 strains, to characterize any divergent strains, and to judiciously modify tests to correct for any deficiencies in sensitivity.     

Opportunistic salpingectomy during postpartum contraception procedures at elective and unscheduled cesarean delivery

ObjectiveTo compare intra- and postoperative surgical complications of opportunistic bilateral total salpingectomy during postpartum permanent contraception procedures in elective and unscheduled cesarean delivery.Study designWe conducted a retrospective cohort study (2010–2017) of women who had postpartum permanent contraception procedures during cesarean delivery, and we collected baseline characteristics, scheduling of delivery (elective versus unscheduled), operative time, estimated blood loss (EBL) and surgical complications (bleeding, iatrogenic injury, infection, anemia and relaparotomy). We classified patients according to contraceptive technique: bilateral total salpingectomy, bilateral partial salpingectomy with or without fimbriae, and other methods.ResultsFive hundred twenty-eight women underwent postpartum permanent contraception procedures, 245 (46.4%) had bilateral total salpingectomy, 239 (45.3%) had bilateral partial salpingectomy, and 48 (8.3%) underwent other methods. We did not find differences in baseline characteristics, operative time and EBL among postpartum permanent contraception groups. Unscheduled cesarean delivery did not influence the choice of postpartum permanent contraception technique (p=.22). Postpartum permanent contraception-related intraoperative bleeding occurred in 1 (0.4%) and 2 (0.9%) patients, respectively, in bilateral total and partial salpingectomy group (p=.23). Postoperative complications were 13 (5.3%) and 6 (2.5%), respectively, in bilateral total and partial salpingectomy groups (p=.11). Subgroup analysis confirmed no differences for intra- and postoperative complications during unscheduled cesarean delivery. We noted a 4.3-min increase in operative time for total salpingectomy after multivariate analysis (p<.01).ConclusionAt maternal request for postpartum permanent contraception during cesarean delivery, bilateral total salpingectomy can be a safe and feasible method even in case of unscheduled cesarean delivery.Implications statementOur results suggest that bilateral total salpingectomy during any cesarean delivery may be an acceptable choice for its higher contraceptive efficacy and risk-reduction effect for ovarian cancer, at the price of a small increase in operative time.     

Expression profiles of PRKG1, SDF2L1 and PPP1R12A are predictive and prognostic factors for therapy response and survival in high-grade serous ovarian cancer

High-grade serous ovarian cancer (HGS-EOCs) is generally sensitive to front-line platinum (Pt)-based chemotherapy although most patients at an advanced stage relapse with progressive resistant disease. Clinical or molecular data to identify primary resistant cases at diagnosis are not yet available. HGS-EOC biopsies from 105 Pt-sensitive (Pt-s) and 89 Pt-resistant (Pt-r) patients were retrospectively selected from two independent tumor tissue collections. Pathway analysis was done integrating miRNA and mRNA expression profiles. Signatures were further validated in silico on a cohort of 838 HGS-EOC cases from a published dataset. In all, 131 mRNAs and 5 miRNAs belonging to different functionally related molecular pathways distinguish Pt-s from Pt-r cases. Then, 17 out of 23 selected elements were validated by orthogonal approaches (SI signature). As resistance to Pt is associated with a short progression-free survival (PFS) and overall survival (OS), the prognostic role of the SI signature was assessed, and 14 genes associated with PFS and OS, in multivariate analyses (SII signature). The prognostic value of the SII signature was validated in a third extensive cohort. The expression profiles of SDF2L1, PPP1R12A and PRKG1 genes (SIII signature) served as independent prognostic biomarkers of Pt-response and survival. The study identified a prognostic molecular signature based on the combined expression profile of three genes which had never been associated with the clinical outcome of HGS-EOC. This may lead to early identification, at the time of diagnosis, of patients who would not greatly benefit from standard chemotherapy and are thus eligible for novel investigational approaches.     

Pattern of bacterial isolates in the middle ear discharge of patients with chronic suppurative otitis media in a tertiary hospital in North central Nigeria

Background

Otitis media (OM) is a major health problem in both developed and developing countries.

Objective

To determine the pattern of bacterial isolates in patients with chronic suppurative otitis media(CSOM) in Ilorin, Nigeria.

Methods

A prospective study carried out in University of Ilorin Teaching Hospital, Nigeria among consenting patients with CSOM attending the ENT clinic over a period of 7months. Informed consent was obtained from the patients or caregivers and approval for the study obtained from ethical committee. Structured questionnaire was administered and microbiological analysis done, data obtained was entered into SPSS statistical software and results presented in tables and figures.

Results

A total of 134 patients aged 5–64yrs with chronic suppurative otitis media were interviewed with a mean age of 17.0 (S.D. =15.1±1.30). About 55.2% of the respondents were under 10yrs. Seventy-two (53.7%) of the respondents were males with M:F=1.2:1. The gram stain showed predominantly gram negative organisms (71.6%). Pseudomonas aeruginosa was the commonest middle ear pathogenic organism identified and the sensitivity pattern highly favoured ciprofloxacin

Conclusion

CSOM is still a childhood problem among the under tens'' more prevalent among males and the commonest agent is Pseudomonas aeruginosa. Ciprofloxacin is still the most sensitive antibiotics in vitro.     

Emerging roles of endoglin/CD105 and angiogenic cytokines for disease development and progression in multiple myeloma patients

Angiogenesis is an essential process for the expansion of multiple myeloma (MM), in which many angiogenic factors participate. Endoglin (CD105) is a transforming growth factor‐β co‐receptor, being mainly expressed in angiogenic endothelial cells and has been used as a marker of tumor angiogenesis, having prognostic potential. The aim of the study was to evaluate serum levels of soluble CD105 (sCD105) in MM patients, both during diagnosis and after effective conventional chemotherapy, in the plateau phase, and to correlate them with the clinical stage of the disease, as well as with the known angiogenic factors vascular endothelial growth factor, angiogenin and interleukin‐18 (IL‐18). Serum levels of the aforementioned factors were measured, by enzyme‐linked immunosorbent assay, in 56 newly diagnosed MM patients, in 35 of them who entered plateau phase and in 24 healthy controls. Bone marrow aspirations were also performed in all patients to determine plasma cell infiltration. All measured cytokines were higher in MM patients compared with controls and with advancing disease stage (p < 0.001 for all cases). Furthermore, the values of all factors decreased significantly in the plateau phase (p < 0.001 for all cases). Serum levels of sCD105 correlated with the other angiogenic cytokines, whereas only serum levels of angiogenin had prognostic value for the survival. In conclusion, CD105 and the angiogenic cytokines vascular endothelial growth factor, angiogenin and IL‐18, seem to have emerging roles both in angiogenesis and tumor growth in MM. Copyright © 2013 John Wiley & Sons, Ltd.     

Prevalence and horizontal propagation of gonococcal infections among Nigerian children

The prevalence and mode of spread of gonococcal infections was studied among prepubertal children in Nigeria. Of 16 children with symptoms suggestive of sexually transmissible diseases (STD), 9 (56%) had gonorrhoea, while no causative organism was found in 7. The majority (7; 78%) of the gonococcal isolates produced penicillinase. Three of the cases were by child-to-child transmission, with female peers as the initiators. Prepubertal children should no longer be ignored as propagators of STD.