A review of incisional hernia repairs: preoperative weight loss and selective use of the mesh repair

At the Shouldice Clinic pre-operative weight loss is used prior to incisional hernia repairs. Mesh repair is selectively used, based on specific hernia characteristics. A series of 236 patients were reviewed and followed up for 36 months. Data were available on 188 patients (80%). There were 15 recurrences (8%). The number of obese patients was reduced from 67 (35.6%) to 25 (13.3%) through the weight loss program. The hernia diameter, gastrointestinal complications, and surgical site infection were significantly related to recurrence but not the type of repair, obesity, location, or previous recurrences. The risk factors of incisional hernias include size, intestinal complications and infections. A selective use has a comparable result to the exclusive use of mesh repair. Weight reduction has yet to be shown to affect the rate of recurrence, and further prospective studies are required.     

Do ethnicity and gender have an impact on pain thresholds in minor dermatologic procedures?

Background and Objectives: The perception of pain is a personal experience influenced by many factors, including genetic, ethnic and cultural issues. Understanding these perceptions is especially important in dermatologic patients undergoing minor surgical operations and who often differ in their pain response to surgical treatments. Little is known about how these differences affect the perception of experimental pain. The purpose of this study was to determine experimental pain perception differences in three distinct East Asian ethnic populations.
Methods: Pain thresholds were examined with a psychophysical computerized quantitative thermal sensory testing device (TSA 2001) in healthy volunteers recruited from three different Asian ethnic groups. Using the methods of limits, experimental pain perception threshold was measured on the forehead and volar aspect of the forearm in 49 healthy subjects. The measurements were then repeated after skin barrier perturbation with adhesive tape stripping of the stratum corneum. All three ethnic groups were analyzed separately with respect to age, gender educational level and skin type.
Results: A total of 20 Chinese, 14 Malay and 15 Indian subjects completed the study. Thermal pain thresholds were similar in all three ethnic groups before and after tape strippings. No significant differences were noted between genders.
Conclusions: Using quantitative sensory thermal testing, we demonstrated that no significant differences in pain occur between different races and genders.     

Paired kidney analysis of tacrolimus and cyclosporine microemulsion-based therapy in Chinese cadaveric renal transplant recipients

Few studies used paired kidneys for comparison between tacrolimus and cyclosporine in renal transplantation. Most of the published data used whole blood trough levels for drug monitoring. However, the use of limited sampling strategy and abbreviated formula to estimate the 12-h area under concentration-time curve (AUC(0-12)) allowed better prediction of drug exposure. Sixty-six first cadaveric renal transplant recipients receiving paired kidneys were randomized to receive either tacrolimus-based (n = 33) or cyclosporine microemulsion (Neoral)-based therapies (n = 33). Abbreviated AUC(0-12) was used for drug monitoring and dose titration. Mean follow-up duration was 2.8 +/- 2 years. The patient and graft survival were comparable. Fewer incidence of acute rejection was observed in tacrolimus group (15% vs. 27.3%) though the difference was not significant (P = 0.23). The absolute value and the rate of decline of creatinine clearance were both significantly better in tacrolimus-treated patients. Prevalence of hypertension, post-transplant diabetes mellitus, infection, and malignancy were similar in both groups. Prevalence of hypercholesterolemia (11/33 vs. 4/33) and gum hypertrophy (6/33 vs. 1/33) was more common in cyclosporine-treated patients (P = 0.04 in both parameters). This was the first prospective, randomized study with paired kidney analysis showing the renal function was significantly better in tacrolimus-treated patients than in cyclosporine-treated patients.     

女性运动试验后QTc与ST的对比分析

作者测量100例妇女心电图运动试验后即刻QTc间期。冠心病组50例运动后即刻QTc间期比静息时明显延长(P<0.001),比正常配对组50例则明显缩短(P<0.001)。以QTc间期延长≥0.01秒力阳性指标,与ST段压低比较,其敏感性可从42％提高至70％,特异性从66％提高至76％;如综合QTc间期与ST段标准加以判断时,可使敏感性、特异性分别增至74％、88％。     

戊二醛交联提高胶原/壳聚糖真皮支架抗细胞收缩能力的研究

目的 应用交联处理的胶原支架,来减缓其降解过多、易收缩变形、机械性能不足等缺点.方法 采用冷冻-冻干法构建胶原/壳聚糖多孔支架,并通过戊二醛交联构建具有良好抗细胞收缩稳定性和细胞相容性的胶原支架.通过测定不同培养时间各类支架的尺寸变化,研究了戊二醛交联对支架抗细胞收缩能力的影响.结果 戊二醛交联后的胶原/壳聚糖支架未见明显收缩,其细胞活性也始终高于干热交联支架.结论 戊二醛能有效地提高胶原基支架的抗细胞收缩能力,并保持其良好的生物相容性.     

Double-orifice mitral valve with intact atrioventricular septum: an echocardiographic study with anatomic and functional considerations.

We identified 18 patients with double-orifice mitral valve (DOMV) and intact atrioventricular (AV) septum out of 40,179 echocardiographic studies performed between 1997 and 2002 at Children's Hospital, Denver, CO. In this study we describe (1) the anatomic characteristics of the DOMV in the absence of AV septal defect, (2) the function of the mitral valve by spectral and color Doppler flow mapping, and (3) associated lesions. The topographic location of the orifices in the leaflets suggests possible embryologic mechanisms of DOMV. In this series, DOMV was most commonly associated with left-sided obstructive lesions (in 39% of patients). Spectral and color Doppler interrogation demonstrated a normal flow profile in most cases; only 2 patients had significant mitral regurgitation or stenosis. Therefore, due to the uncertain natural history of this lesion and the potential need for endocarditis prophylaxis, careful imaging of the mitral valve is recommended, particularly in the presence of left-sided obstructive lesions.     

The correlation between TNF-α, IL-6 in cervical mucous during follicular development and ovulation stimulation in different protocols

Objective To investigate the correlation between TNF-α and IL-6 levels in cervical mucous during follicular development and ovulation stimulation in different protocols.Methods 36 infertile women were set up as experimental groups,divided into CC, HMG, IVF-ET group,each group consisted of 12 infertile women and 15 women with normal menstrual cycles were choiced as control group.Cervical mucous during follicular phase, luteal phase and ovulation phase were collected.TNF-α, IL-6 levels in cervical mucous were measured by radioimmunology assay (RIA).Follicular development were monitored by transvaginal ultrasonagraphy.Results (1) TNF-α levels in cervical mucous of experimental groups and control group were periodically various among the reproductive cycle.It increased during follicular phase, reached to peak during ovulation phase, and decreased during luteal phase (P＜0.05).IL-6 levels had no obvious periodical changes.(2) Compared with CC and control group, levels of TNF-α,IL-6 in HMG and IVF-ET group were significantly higher (P＜0.05).(3) Levels of TNF-α and IL-6 in cervical mucous were positively correlated with the dominant follicle diameter (r=0.261, r=0.192 respectively,P＜0.05).(4) TNF-α and IL-6 showed positive correlation in the reproductive cycle (r=0.782,P＜0.05).Conclusions (1) TNF-α level shows a cyclic change in the reproductive cycle and peaks during ovulation,whereas IL-6 level does not.(2) TNF-α and IL-6 may play a certain role in the process of follicular development and ovulation.(3)The levels of TNF-α and IL-6 are up-regulated by gonadotrophic hormone.(4) TNF-α and IL-6 may have coordination properties and participate in the same biological effects.     

Influence of TAT-peptide polymerization on properties and transfection activity of TAT/DNA polyplexes.

Use of bioactive cationic peptides as gene carriers is limited by instability of their DNA complexes in vivo and by the loss of their biological activity due to undesired interactions of their bioactive parts with the DNA. To overcome the two major limitations, biodegradable high-molecular-weight form of TAT peptide (POLYTAT) sensitive to cellular redox-potential gradients was synthesized in this study by oxidative polycondensation. Physicochemical and transfection properties of DNA polyplexes based on POLYTAT were investigated and compared with polyplexes based on TAT polymer prepared by in situ template-assisted polymerization. Physicochemical properties of TAT-based polyplexes were affected by the molecular weight and method of polymerization of the TAT peptide. All TAT-based DNA polyplexes exhibited reduced cytotoxicity when compared with control polyethylenimine (PEI) polyplexes. Polyplexes based on both high-molecular-weight TAT polypeptides exhibited increased transfection efficiency compared to control TAT peptide but lower than that of PEI polyplexes. The evidence shows that transfection activity of TAT-based polyplexes is strongly dependent on the presence of chloroquine and therefore suggests that TAT polyplexes are internalized by an endocytosis. Overall, high-molecular-weight reducible polycations based on bioactive peptides has the potential as versatile carriers of nucleic acids that display low cytotoxicity and can prove to be especially beneficial in cases that require surface presentation of membrane-active or cell-specific targeting peptides.     

黄芪、雷公藤多甙对大鼠肾小球系膜细胞分泌IL-6的影响

目的:观察黄芪和雷公藤多甙对大鼠肾小球系膜细胞分泌IL-6水平的影响.方法:应用细胞培养技术进行肾小球系膜细胞培养,采用血清药理学方法,制备黄芪药物血清,雷公藤多甙药物血清,并分为低、中、高3个剂量梯度,观察药物血清对正常状态下肾小球系膜细胞分泌IL-6的影响,采用细胞ELISA法测定IL-6含量.结果:黄芪、雷公藤多甙各不同剂量组均可抑制肾小球系膜细胞产生IL-6,其抑制作用随剂量增加而增殖,其中尤以雷公藤高剂量组、中剂量组及黄芪高剂量组作用明显.结论:黄芪可抑制肾小球系膜细胞分泌IL-6,这一作用与雷公藤类似.这可能是黄芪防治肾小球硬化的作用机制之一.