Using Middle Ear Risk Index and ET Function as Parameters for Predicting the Outcome of Tympanoplasty

Otitis media is an important and a highly prevalent disease of the middle ear and poses serious health problem world wide especially in developing countries where large percentage of the population lack specialized medical care. With a large number of patients frequently undergoing tympanoplasty for tubotympanic type of CSOM, it’s important to assess the severity of the disease and predict the outcome of the surgical management whenever done. A normally functioning eustachian tube is an equally essential physiologic requirement for a healthy middle ear and normal hearing. In this study we have used the middle ear risk index (MERI) developed by Kartush which generates a numeric indicator of the severity of the middle ear disease to stratify patient groups according to the severity of the disease and to evaluate the efficiency of MERI score in predicting the outcome of tympanoplasty.     

Perspectives on pain and intellectual disability

Historically, individuals with intellectual disability (ID) have been excluded from pain research and assumed to be insensitive or indifferent to pain. The weight of the evidence suggests that individuals with ID have been subject to practices and procedures with little regard for their ability to experience or express pain. A number of issues central to improving understanding of pain in ID will be introduced and current research related to the definition of pain and its social context, underlying sensory and metabolic systems and factors influencing judgments about the ability to experience pain will be reviewed. Accumulating evidence from interdisciplinary research designed to improve assessment, understand individual differences, and evaluate bias and beliefs about pain suggests that new perspectives are emerging and beginning to shape an innovative frontier of research that will ultimately pay tremendous dividends for improving the quality of life of individuals with ID.     

脂多糖对成纤维细胞基质金属蛋白酶及金属蛋白酶组织抑制因子表达的影响

目的观察脂多糖（LPS）对成纤维细胞基质金属蛋白酶（MMPs）及其抑制物金属蛋白酶组织抑制因子（TIMPs）表达的变化，探讨伤口感染时LPS对伤口愈合的可能影响。方法将体外培养的人成纤维细胞加入不同浓度的LPS（10、100、1000μg／ml后，用荧光标记的明胶酶谱法和反向酶谱法测定培养液中MMPs及TIMPs表达的变化，并用电泳分析软件对黑色条带（MMPs）或亮色条带（TIMPs）的面积及密度进行半定量分析。结果LPS可以上调成纤维细胞的MMP-2、TIMP-1和TIMP-2的表达，且TIMPs增加的程度大于MMPs。10、100、1000μg／ml的LPS使MMP-2分别增加为基值的1．3、1．7、1．6倍，TIMP-1分别为3、4．5、3．5倍，TIMP-2分别为3、6、5．6倍。结论LPS在伤口愈合过程中成纤维细胞表达MMPs和TIMPs的环节上，对伤口愈合没有明显的不利影响。     

Frequency-domain photon migration measurements for quantitative assessment of powder absorbance: A novel sensor of blend homogeneity.

The measurement and analysis of frequency-domain photon migration (FDPM) measurements of powder absorbance in pharmaceutical powders is described in the context of other optical techniques. FDPM consists of launching intensity-modulated light into a powder and detecting the phase delay and amplitude modulation of the re-emitted light as a function of the modulation frequency. From analysis of the data using the diffusion approximation to the radiative transport equation, the absorption coefficient can be obtained. Absorption coefficient measurements of riboflavin in lactose mixtures are presented at concentrations of 0.1 to 1% (w/w) at near-infrared wavelengths where solution absorption cross sections are difficult to accurately measure using traditional transmission measurements in nonscattering solutions. FDPM measurements in powders enabled determinations of absorption coefficients that increase linearly with concentration (w/w) according to Beer-Lambert relationship. The extension of FDPM for monitoring absorbance of low-dose and ultralow-dose powder blending operations is presented.     

Endoscopic retrograde cholangiopancreatography after laparoscopic Roux-en-Y gastric bypass: a case series and review of the literature

Endoscopic retrograde cholangiopancreatography (ERCP) has become an important tool in the diagnosis and treatment of pancreaticobiliary pathology. ERCP in patients that have undergone Roux-en-Y gastric bypass (RYGB) is particularly challenging because traditional transoral endoscopy may be limited. We present our experience with ERCP after RYGB and review the literature. In 2007 eight patients underwent ERCP after RYGB using open or laparoscopic transgastric access. After introduction of pneumoperitoneum, a total of four ports were placed. A purse-string was placed around a gastrotomy 4 to 6cm proximal to the pylorus. The endoscope was introduced through a 15 mm left-upper-quadrant port and the gastrotomy. Endoscopy was then performed. Laparoscopic gastrotomy was used in all patients that underwent a previous laparoscopic Roux-en-Y gastric bypass (LRYGB) (n = 6) and open gastrotomy was used for patients with a previous open RYGB (n = 2). Cannulation and interventions in the pancreaticobiliary tree were successful in all cases. There were no postoperative complications. Laparoscopic transgastric ERCP after LRYGB is feasible, highly successful, may be performed expeditiously, and does not seem to add significant morbidity to the procedure. The ability to perform ERCP in this patient population is critical due to their tendency to have preexisting biliary disease and to develop gallstones and the associated complications.