Use of surgisis mesh in laparoscopic repair of hiatal hernias

BACKGROUND: Breakdown of the crural closure is a frequent reason for failure of antireflux surgical procedures. This retrospective study aimed to determine the effectiveness of using absorbable mesh in preventing recurrence of hiatal hernia after posterior cruroplasty. DESIGN: Comparative retrospective analysis. METHOD: The charts of 220 adults who underwent antireflux surgery with posterior cruroplasty between 1997 and 2005 were retrospectively reviewed. Patients were divided into 2 groups: posterior cruroplasty+absorbable mesh reinforcement (n=127) and posterior cruroplasty alone (n=93). Symptomatic outcome was assessed by telephone interview in 92 patients (72%) in the mesh group at a median of 3.2 years postoperatively and 59 patients (63%) in the no mesh group of men studied at a median of 3.8 years postoperatively. MAIN OUTCOME MEASURES: Incidence of recurrence and persistent symptoms. RESULTS: In the mesh group, 74/92 (80%) patients remained asymptomatic at a median of 3.2 years postoperatively. Of these patients, 31 underwent either an upper endoscopy or an upper gastrointestinal (UGI) series; none had recurrence of hiatal hernia. Of the 18 symptomatic patients, 13 underwent an upper endoscopy or an UGI series to determine the etiology of symptoms; 3 recurrences were confirmed for a 3.3% overall proven recurrence rate. In the no mesh group, 26/59 (44%) patients were symptomatic. Of these, 18 underwent either an upper endoscopy or an UGI series. Recurrence of hernia was confirmed in 12 patients for a 20% overall proven recurrence rate. There were no instances of mesh infection or erosion. CONCLUSIONS: Symptomatic recurrence rates of hiatal hernia after antireflux surgery vary. Recurrence of a hiatal hernia may or may not lead to symptoms. This retrospective analysis demonstrates that absorbable mesh is safe and may lead to a significant reduction in the incidence of symptomatic recurrent hiatal hernia.     

Cell cycle-dependent nuclear export of phosphatase and tensin homologue tumor suppressor is regulated by the phosphoinositide-3-kinase signaling cascade

The tumor suppressor phosphatase and tensin homologue (PTEN) plays distinct growth-regulatory roles in the cytoplasm and nucleus. It has been shown to be preferentially localized to the nucleus in differentiated or resting cells, and to the cytoplasm in advanced tumor cells. Thus, the regulation of PTEN's subcellular localization seems to be critical to its tumor-suppressing functions. In this study, we showed that activation of the phosphoinositide-3-kinase (PI3K) pathway triggers PTEN's cell cycle-dependent chromosome region maintenance 1-mediated nuclear export, as PTEN was predominantly expressed in the cytoplasm of TSC2(-/-) mouse embryo fibroblasts or activated Akt mutant-transfected NIH3T3 cells. In contrast, dominant-negative mutants of Akt and pharmacologic inhibitors of PI3K, mTOR, and S6K1, but not of MEK, suppressed the nuclear export of PTEN during the G(1)-S transition. The nuclear-cytoplasmic trafficking of exogenous PTEN is likewise regulated by the PI3K cascade in PTEN-null U251MG cells. The nuclear export of PTEN could also be blocked by short interfering RNA to S6K1/2. In addition, PTEN interacts with both S6K1 and S6K2. Taken together, our findings strongly indicate that activation of the PI3K/Akt/mTOR/S6K cascade, specifically S6K1/2, is pivotal in regulating the subcellular localization of PTEN. This scenario exemplifies a reciprocal regulation between PI3K and PTEN that defines a novel negative-feedback loop in cell cycle progression.     

互动性月度教育简报在提高医生实践水平中的作用

1 介绍 美国的血液供应情况不容乐观,很多地区都存在血液储备不足的情况.随着人口老龄化问题日趋严重,对供血量的要求日益增加.同时为了减少输血传播疾病的风险,对献血者的要求也越来越严格,导致了有效献血者数量的减少.因此对于很多患者来说,输血的治疗费用比较昂贵.     

Measurement of Serum Antigen Concentration by Ultrasound-Enhanced Immunoassay and Correlation with Clinical Outcome in Meningococcal Disease

 The distribution of Neisseria meningitidis serogroup B and C polysaccharide antigen in blood and the prognostic significance of antigen concentration was examined by ultrasound-enhanced immunoagglutination of coated microparticles. Specimens (169 sera/plasma from 145 patients with confirmed meningococcal disease) were tested retrospectively. The ultrasonic immunoassay detected serum antigen in 136 samples from 112 patients. Titration of antigen-positive specimens allowed estimation of blood antigen concentration. The modal blood antigen titre was 1/16, corresponding to an estimated polysaccharide concentration of 0.85 μg/ml. The lowest mean blood antigen concentration found ultrasonically was 0.05 μg/ml; compared to the 1.98 μg/ml found by conventional latex agglutination, this represents an approximately 30-fold improvement in sensitivity. Three grades of outcome were correlated with the presenting antigen titre in 83 patients: (i) <2 weeks hospitalisation, (ii) ≥2 weeks hospitalisation and (iii) mortality. High polysaccharide concentrations correlated with mortality. Nine of 15 patients with a serum antigen titre of 1/64 or greater (≥3.4 μg/ml polysaccharide) died, whereas no patient with titres equal to or less than 1/4 (≤0.21 μg/ml) died, including those patients in whom antigen was undetectable by ultrasonic immunoassay. Increasing antigen concentration significantly correlated with severity of outcome (P<0.001). Ultrasound-enhanced agglutination provides a rapid prognostic indicator by sensitive measurement of serum antigen level.     

Clinical and Epidemiological Aspects of the Emerging Adenovirus 14p1, Part II

Human adenovirus serotype 14 (HAdV-14; agent de Wit), a subspecies B2 member, was first identified in The Netherlands in 1955 in a military training camp and last reported in Eurasia in 1963. This virus has been conspicuous by its absence in global serosurveys and surveillance in subsequent decades. In early 2006, HAdV-14 was described at five military training centers in the United States and was subsequently associated with civilian cases of severe respiratory disease and fatalities in New York and California. In 2007, 140 cases of HAdV-14 were identified in outbreak clusters across the U.S. (Oregon, Washington, and Texas), with 37% requiring hospitalization, 17% admittance to intensive care units, and a 5% mortality rate. Genetic characterization of this emerging HAdV-14 revealed a novel genome variant (termed HAdV-14p1), and an identical virus has recently been detected in Europe, also associated with morbidity and mortality in both immunocompromised and immunocompetent individuals. As a recently emerged virus, HAdV-14 has an increased potential for high rates of transmission and high attack rates due to low levels of herd immunity, simply because the vast majority of individuals are extremely likely to have never been exposed. Part I of this two-part article reviewed the classification of HAdV-14p1; the clinical symptoms associated with this virus, including case reports; and risk factors associated with these infections. Part II of this article reviews the epidemiology, diagnosis, prevention, and treatment modalities of HAdV-14p1.     

Perceptual discrimination of speech sounds in developmental dyslexia.

Experiments previously reported in the literature suggest that people with dyslexia have a deficit in categorical perception. However, it is still unclear whether the deficit is specific to the perception of speech sounds or whether it more generally affects auditory function. In order to investigate the relationship between categorical perception and dyslexia, as well as the nature of this categorization deficit, speech specific or not, the discrimination responses of children who have dyslexia and those of average readers to sinewave analogues of speech sounds were compared. These analogues were presented in two different conditions, either as nonspeech whistles or as speech sounds. Results showed that children with dyslexia are less categorical than average readers in the speech condition, mainly because they are better at discriminating acoustic differences between stimuli belonging to the same category. In the nonspeech condition, discrimination was also better for children with dyslexia, but differences in categorical perception were less clear-cut. Further, the location of the categorical boundary on the stimulus continuum differed between speech and nonspeech conditions. As a whole, this study shows that categorical deficit in children with dyslexia results primarily from an increased perceptibility of within-category differences and that it has a speech-specific component. These findings may have profound implications for learning and re-education.