Ventricular shunt therapy of the brain: long-term rubber-catheter- induced inflammation

Three cases of catheter-induced inflammation are presented, two of which involved brain parenchyma and the ventricular system and one that involved the soft tissues of the scalp. All of the catheters were composed of natural rubber and had been in place for several years. Abnormalities seen on computed tomographic scans in these patients were variable but included mass effect, vasogenic edema, catheter destruction, calcification, and abnormal contrast enhancement of the parenchyma adjacent to the catheters. Certain features on the scans of the two patients with intracranial disease, however, were common to both cases, allowing the correct preoperative diagnosis to be made in the second patient encountered.     

Angiotensin II receptor antagonists in heart failure: Rationale and design of the evaluation of losartan in the elderly (ELITE) trial

Summary Angiotensin-converting enzyme inhibitors (ACE-I) have been proven to be effective in reducing morbidity and mortality in patients with heart failure or post-myocardial infarction left ventricular dysfunction. Despite evidence from several large-scale randomized trials, the use of ACE-I in patients with heart failure remains relatively low. In part, the failure to achieve more widespread use of ACE-I in patients with heart failure may be due to physician's perceptions of the side effects associated with ACE-I, such as angioedema, renal dysfunction, cough, and hypotension. Many of these side effects are thought to be due to ACE-I-induced bradykinin accumulation. It is possible to inhibit the effect of angiotensin II without increasing bradykinin levels using an angiotensin II type I blocking agent such as losartan. How effective losartan is compared with an ACE-I is uncertain, however. Some of the beneficial effects of ACE-I have been attributed to bradykinin accumulation, and therefore ACE-I might have an advantage compared with an angiotensin II type I receptor antagonist such as losartan. On the other hand, angiotensin II may be produced by non-ACE-I-dependent mechanisms, which would suggest that an angiotensin II type I receptor blocking agent would be advantageous. To determine the relative safety and efficacy of an ACE-I, which results in bradykinin accumulation and inhibitors of angiotensin II, versus an angiotensin II type I receptor blocking agent, which does not result in bradykinin accumulation, we have begun the Evaluation of Losartan In The Elderly (ELITE) trial, which will compare the safety and efficacy of captopril and losartan in elderly patients with heart failure.     

精神分裂症患者的社交技能训练小组活动方案

目的:通过社交技能训练让精神分裂症患者明确正确的沟通方式,锻炼自己的交谈能力,学会社会交往技巧,体会人与人之间的关系,学会分析解决社交过程中出现的问题,从而掌握社会交往的技能,防止或延缓发生严重的社会功能衰退。方法:选择早期精神分裂症患者(5年内),在住院治疗达到临床治愈出院后立即开始训练。活动以小组为单位(10人1组)进行,小组成员相对固定。前3个月每个月1次,以后每3个月1次,持续1年。活动过程中以游戏为主导,让组员在游戏中领会人际交往过程中的要领。具体训练方案包括6个方面:①训练一:语言表达能力,正确的沟通方式。②训练二:如何寻找帮助。③训练三:指导患者学习人际交往的基本技巧。④训练四:如何与人打交道。⑤训练五:合作。⑥训练六:社交问题的解决。结果:通过增加对社交时恐惧的暴露及社交技巧训练,对精神分裂症伴发社交恐惧症有效;但对精神分裂症意志活动减退所致社交时主动性不足效果较差。结论:对精神分裂症患者的社交训练应尽早进行,同时在设计精神分裂症社交训练时应加强对患者主动性不足的针对性。     

Cellular response of preosteoblasts to nanograined/ultrafine-grained structures

Metallic materials with submicron- to nanometer-sized grains provide surfaces that are different from conventional polycrystalline materials because of the large proportion of grain boundaries with high free energy. In the study described here, the combination of cellular and molecular biology, materials science and engineering advances our understanding of cell–substrate interactions, especially the cellular activity between preosteoblasts and nanostructured metallic surfaces. Experiments on the effect of nano-/ultrafine grains have shown that cell attachment, proliferation, viability, morphology and spread are favorably modulated and significantly different from conventional coarse-grained structures. Additionally, immunofluorescence studies demonstrated stronger vinculin signals associated with actin stress fibers in the outer regions of the cells and cellular extensions on nanograined/ultrafine-grained substrate. These observations suggest enhanced cell–substrate interaction and activity. The differences in the cellular response on nanograined/ultrafine-grained and coarse-grained substrates are attributed to grain size and degree of hydrophilicity. The outcomes of the study are expected to reduce challenges to engineer bulk nanostructured materials with specific physical and surface properties for medical devices with improved cellular attachment and response. The data lay the foundation for a new branch of nanostructured materials for biomedical applications.