Arterial occlusive disease below the knee: treatment with percutaneous transluminal angioplasty performed with low-profile catheters and steerable guide wires

In 98 patients with arterial occlusive disease below the knee who were candidates for limb salvage surgery, percutaneous transluminal angioplasty (PTA) was performed with a low-profile balloon catheter and steerable guide wire system. Sixteen patients had bilateral disease; thus, there were 114 endangered limbs and 145 diseased vessels, including 19 with a single stenosis, 94 with multiple stenoses, and 32 with total occlusions. Primary anatomic success was achieved in all stenosed vessels and in 28 occluded vessels. Initial limb healing without amputation was achieved in 88% of limbs. In four patients occluded vessels could not be recanalized; thus, the four affected limbs were amputated. Two years after PTA, 32 of 37 patients available for follow-up had viable pain-free extremities. Cumulative limb salvage rate at 2 years was 86%. At this time, below-the-knee PTA is still recommended only for limb salvage candidates. However, with this new catheter and guide wire system, success rates have been increased and complication rates decreased. PTA may be useful in selected patients with severe claudication.     

经尿道等离子双极电切术与TURP治疗前列腺增生疗效比较

1对象和方法1 1.1对象2003-10/2005-02治疗前列腺增生症(benign prostatic hyperplasia, BPH)患者215例,年龄48～86(平均71.2)岁.     

Invasive pulmonary aspergillosis and acute leukemia. Limitations in the diagnostic utility of the air crescent sign

The air crescent sign is regarded as an important diagnostic finding in invasive pulmonary aspergillosis (IPA). This study examined the incidence, clinical importance, and natural history of air crescents in 25 patients with acute leukemia and IPA. Twelve (50%) of the patients had cavities (ten with an air crescent) that appeared an average of 15 days after the initial infiltrate. The diagnostic utility of the air crescent sign was relatively minor; cavities developed after the diagnosis was established in 50% of cases and after therapy was started in 75% of cases. In each case, the pneumonia improved at the time of cavitation. In six patients (50%), the cavities resolved over 2-8 months. Three patients (25%), however, experienced massive hemoptysis. Air crescent formation, previously shown to be dependent on granulocyte recovery, was associated with improved survival (67%) compared with the group without cavitation (8%). In the latter group, the pneumonia in ten (77%) of 13 patients progressed to diffuse disease. In patients with leukemia, the diagnostic value of the air crescent sign is limited by cavities that develop relatively late, as the infection improves after white blood cell recovery; cavities that do not occur in patients who remain neutropenic; and associated hemorrhage, at times life-threatening, that obscures the air crescent. The diagnosis of IPA should not await observation of air crescents in these patients.     

骨替代材料纳米生物陶瓷粉体的制备技术

目的:纳米材料由于其尺寸效应,可以改善材料的力学性能,实验在对纳米生物陶瓷粉体制备技术研究基础上,探索活性和惰性骨替代纳米生物陶瓷粉体的制备方法,为纳米生物材料的临床应用奠定基础。方法:分别采用化学反应法和醇-水溶液加热法制备纳米羟基磷灰石和纳米Al2O3-ZrO2复合粉体,同时结合X射线衍射、透射电镜等分析测试手段对获得的纳米粉体进行了成分和微观形态分析。结果:①在制备羟基磷灰石粉体的溶液pH值在10.5￣11.0范围内,可制得粒度为30￣80nm的纳米羟基磷灰石粉体。②在制备Al2O3-ZrO2复合粉体的反应物浓度为0.05￣0.15mol/L范围内,可制得纳米粒度为10￣20nm的Al2O3-ZrO2复合粉体。结论:采用化学反应法和醇-水溶液加热法可以制备出活性和惰性纳米生物陶瓷粉体,用作骨替代材料,满足临床医用的需要。     

β-巯基乙醇在大鼠骨髓基质细胞向神经干细胞诱导分化中的作用

目的:探讨骨髓基质细胞诱导分化为神经干细胞的更佳培养液组成。方法:实验于2005-10/2006-08在省级实验室北华大学医学院实验中心完成。①实验材料:体质量120～160g的Wistar大鼠,由北华大学动物中心提供。②实验方法:取120～160g大鼠3只,体外分离培养大鼠骨髓基质细胞。培养约14d,待原代细胞贴满培养瓶,呈成纤维细胞样生长,用0.25%胰蛋白酶消化原代细胞约3min,在倒置显微镜下见贴壁细胞基本收缩成类圆形后,加入含胎牛血清的DMEM培养液终止消化,并将细胞液吹打均匀,以1×107L-1接种于2个细胞培养瓶中进行1∶2传代扩增培养。在传代培养细胞培养液中加入神经细胞诱导剂,选取生长良好的2,3,4代细胞进行实验。取第5代培养细胞,以8×103/cm2接种于预铺有盖玻片3.5cm培养皿中制备细胞爬片,每孔加入含体积分数为0.1胎牛血清的DMEM培养液2mL,达80%融合时更换新鲜培养液,并在培养液中加入1mmol/Lβ-巯基乙醇,诱导24h,磷酸盐缓冲液洗涤,换成含1mmol/Lβ-巯基乙醇的无血清培养液,5h后更换为改良神经细胞培养液,并设立未加入含β-巯基乙醇培养液的为对照。利用免疫组织化学方法检测神经元特有巢蛋白。结果:①培养的骨髓基质细胞形态学变化:接种初期,细胞贴壁生长是以分散的、克隆集落方式增殖,细胞呈圆形漂浮于培养液中,培养10d后,细胞形态基本为纺锤形的成纤维细胞样,偶有宽大扁平的多边形细胞,细胞逐渐长出小突起,出现出芽现象,14～20d后,突起细胞增多,突起延长并相互连接成网,具有神经细胞形态特征。②免疫组织化学染色检测神经元特有巢蛋白:1周左右,细胞可表达巢蛋白阳性,细胞大而圆,呈棕褐色,经培养诱导分化2周后的长突起细胞,表达神经元特异性抗原巢蛋白阳性细胞互相成网状连接。实验组第4代90%细胞巢蛋白阳性,在荧光显微镜下细胞发黄绿荧光,对照组第1代细胞约30%细胞呈巢蛋白阳性,荧光弱。结论:在诱导培养液中加入β-巯基乙醇,可明显促进骨髓基质细胞的分化,并可获得神经干细胞。     

Pyruvate kinase Greensboro. A four-generation study of a high K0.5s (phosphoenolpyruvate) variant [published erratum appears in Blood 1988 Dec;72(6):2082]

The proband with lifelong hemolytic anemia has a high K0.5s phosphoenolypyruvate (PEP) erythrocyte pyruvate kinase (PK) variant substantially but incompletely normalized by the allosteric modifier fructose-1,6-diphosphate (F-1,6-P2) with conversion of sigmoidal to hyperbolic kinetics. Heterozygotes in four generations express qualitatively identical but less severely abnormal kinetics and lack overt hemolysis. Kinetic abnormalities are closely mimicked by sulfhydryl modification of normal PK. Three distinct clinical and metabolic phenotypes characterize the proband and two sisters: variant PK and hemolytic anemia, variant PK without clinical manifestations or hemolysis, and complete normality. Their mother, whose red cell PK is entirely normal except for a questionably slightly low Vmax, is postulated to express the gene products of nonidentical alleles, one encoding a product with mildly less favorable catalytic characteristics. At low PEP concentrations, the proband and heterozygotes for the PK mutant express only a very small fraction of normal PK activity despite apparent inheritance of one normal allele in the latter. Evidence suggests that disproportionately lowered PK activity may be a property of a heterotetrameric PK. Illusory abnormalities in nucleotide specificity are artifacts of diminished substrate affinity characterizing the mutant PK.     

Modular headache theory

Many people experience headaches that do not fulfil the International Headache Society's criteria for a specific headache disorder yet behave biologically like that disorder. Others fulfil criteria for one headache disorder and yet have features of another disorder. To explain these observations, we propose that groups of neurones called modules become activated to produce each symptom of a primary headache disorder, and that each module is linked to other modules that together produce an individual's headache. This theory has implications for the classification, research and treatment of primary and secondary headache patients.     

Predicting regional control based on pretreatment nodal size in squamous cell carcinoma of the head and neck treated with chemoradiotherapy: A clinican’s guide

The aim of this study was to determine the regional control rate with concurrent chemoradiotherapy (CRT) based on pretreatment nodal size in mucosal head and neck squamous cell carcinoma (HNSCC) in patients who achieved a complete response (CR) at the primary site by 12 weeks post‐treatment. Between December 1997 and November 2003, 117 patients with node‐positive HNSCC were treated with concurrent CRT, with 108 (92%) achieving a CR at the primary site by 12 weeks. There were 93 males (86%), median age 55 (37–79) years and the most common primary site was the oropharynx (65%). Patients were divided into three subgroups: ≤3.0 cm 70 (65%), 3.1–6.0 cm 30 (28%) and ≥6.1 cm 8 (7%). All patients received concurrent platinum‐based chemotherapy and the median radiation dose was 70 Gy (60–72 Gy). The 3‐year regional control rate based on pretreatment nodal size was ≤3.0 cm 88% (95% confidence interval (CI) 78–94%), 3.1–6.0 cm 72% (95%CI 49–86%) and ≥6.1 cm 50% (95%CI 15–77%) (P = 0.001). The 3‐year regional control rate based on pre‐treatment nodal size was ≤3.0cm 88% (95%CI 78–94%), 3.1–6.0 cm 72% (95%CI 49–86%) and ≥6.1 cm 50% (95%CI 15–77%) (P = 0.001). These results provide a quantitative guide for the clinician as to the likelihood of regional control based on pretreatment nodal size following CRT in patients who achieve a CR at the primary site by 12 weeks post‐treatment.