Further evidence of construct validity of standardized patient‐based performance examinations

The purpose of this study was to gather additional evidence pertinent to the construct validity of standardized patient‐based clinical performance examinations. Specifically, the study determined whether students who indicated they had previously read about, seen, or worked up a case on the examination performed differently on that case from those students who had not. Overall, it was found that students with previous reading or direct experiences with cases on the test tended to have higher case mean scores on those cases than those who had not. These results demonstrated that scores on standardized patient‐based performance examinations are sensitive to the examinees’ various learning experiences.     

In vivo assessment of wall shear stress in the atherosclerotic aorta using flow‐sensitive 4D MRI

Our purpose was to correlate atherogenic low wall shear stress (WSS) and high oscillatory shear index (OSI) with the localization of aortic plaques. Flow‐sensitive four‐dimensional MRI was used to acquire three‐dimensional blood flow in the aorta of 62 patients with proven aortic atherosclerosis and 31 healthy volunteers. Multiplanar data analysis of WSS magnitude and OSI in 12 wall segments was performed in analysis planes distributed along the aorta. Disturbed WSS and OSI were defined as areas exposed to low WSS magnitude and high OSI beyond individual 15% thresholds. Planewise analysis revealed a good correlation (r = 0.85) of individual low WSS magnitude but not of high OSI with plaque distribution. Although plaques occurred only rarely in the ascending aorta, the incidence of low WSS magnitude and high OSI was similar to findings in other aortic segments where plaques occurred more frequently. Case‐by‐case comparisons of plaque location and critical wall parameters revealed a shift of atherogenic WSS magnitude (78% of all cases) and OSI (91%) to wall segments adjacent to the atheroma. Our results indicate that the predictive value of WSS for plaque existence depends on the aortic segment and that locations of critical wall parameters move to neighboring segments of regions affected by atherosclerosis. Magn Reson Med, 2010. © 2010 Wiley‐Liss, Inc.     

Bronchial migration of pulmonary arterial coil

Transcatheter embolization was performed with stainless steel coils in a patient with bilateral pulmonary arterial aneurysms of unknown etiology. After a successful initial procedure, endobronchial migration of one of the coils was found which required surgical treatment. Indications of embolization and different types of materials are discussed.     

The influence of health care on contraceptive acceptance in rural Mexico

This paper offers two types of evidence in support of the idea that family planning services are most expediently provided as an integral part of the health and medical organization for maternity care. First, prenatal care and medical attention at delivery are found to be closely associated with postpartum contraceptive acceptance in a 1981 survey of family planning in rural Mexico. Second, interviews of a sample of doctors, nurses, and auxiliaries who provide maternal health services to the rural population reveal that these practitioners favor long birth intervals and small completed families, that they recommend the use of modern contraceptive methods including female sterilization, and that those in the employ of public institutions are motivated to recruit acceptors of these methods. The main impediment to contraceptive acceptance in this context is believed to be fear of side effects and permanent health consequences rather than the desire for additional children.     

Nannizzia incurvata in Hue city - Viet Nam: Molecular identification and antifungal susceptibility testing

BackgroundNannizzia incurvata, a species belonging to the Nannizzia gypsea complex, is considered a neglected pathogen.ObjectiveTo detected N. incurvata isolates from dermatophytosis patients in Hue city - Viet Nam, and test the antifungal susceptibility of this species. Moreover, fungal capability to produce hydrolytic enzymes was evaluated.MethodsPatients’ samples were collected and cultured on Sabouraud-chloramphenicol-cycloheximide medium. Dermatophytes isolates were initially macroscopically and microscopically identified. ITS PCR-RFLP and ITS rDNA sequences were performed to determine and confirm species. An ITS Neighbor-Joining phylogenetic tree evaluated the genetic relationship among isolates. Fungal hydrolytic enzymes were examined, including lipase, phospholipase and protease. Antifungal susceptibility testing was carried out by the disk diffusion method. MICs of itraconazole, voriconazole, and terbinafine against these isolates were determined by the broth microdilution method.ResultsTwelve isolates of N. gypsea complex were preliminary morphologically identified. PCR-RFLP and ITS-rDNA sequencing identified and confirmed dermatophytes as N. incurvata strains, respectively. An evident polymorphism among isolates was highlighted in the phylogenetic tree. All isolates showed the activity of lipase, phospholipase, and protease production. Overall, all N. incurvata isolates were susceptible to itraconazole, voriconazole, clotrimazole, miconazole, and terbinafine. Few isolates were susceptible to griseofulvin, and none of them were susceptible to fluconazole.ConclusionsThere was a presence of polyclonal N. incurvata isolates in dermatophytosis patients from Hue city, identified by PCR-RLFP and confirmed by ITS sequencing. We confirmed PCR-RLFP as a reliable technique to identify this species. Azole and terbinafine are the optimal choices for N. incurvata treatment except for fluconazole.     

Sweeteners and beta-glucans improve metabolic and anthropometrics variables in well controlled type 2 diabetic patients

The introduction of fat and carbohydrates replacers has been a revolutionary advance in treating obesity and diabetes mellitus. Since these materials have shown to have beneficial effects on the metabolic profiles of diabetic patients, they should be useful in designing specific foods for patients with diabetes. OBJECTIVE: To compare metabolic and anthropometric improvements elicited by a diet based on the American Diabetic Association's nutrition recommendations with a modified, low-energy diet incorporating fat replacers and non-sucrose sweeteners. DESIGN: A total of 16 male, well controlled type 2 diabetes patients were divided into two groups of eight; one group received the diet based on the American Diabetic Association's nutrition recommendations, and the other was fed a modified, low-calorie diet containing a fat replacer (beta-glucans derived from oats) and the sweeteners, sucralose and fructose. Both groups were maintained on their respective diets for 4 weeks. All patients performed daily aerobic exercise consisting of walking for 60 minutes. Body weight, body mass index, basal glycemia, hemoglobin HbA1C, and lipid profile were determined in each patient before starting the diets and after 4 weeks of dietary intervention. RESULTS: Both diets produced significant improvements in weight, body mass index, lipid profile, basal glucose, and HbA1C. However, the experimental diet was superior to the American Diabetic Association's diet in improving metabolic and anthropometric profile: greater increase in HDL cholesterol and larger decreases in HbA1C, weight, and body mass index. CONCLUSIONS: A diet incorporating a fat replacer and non-sucrose sweeteners produced a greater improvement in metabolic and anthropometric variables in well controlled type 2 diabetic patients when compared with a diet based on American Diabetic Association's nutrition recommendations.     

外用中药联合表皮细胞生长因子促进骨外露创面的愈合

目的:表皮细胞生长因子具有参与和促进创伤后组织修复的功能,但单独使用效果不理想,通过使用肤疾骨宁膏联合表皮细胞生长因子方法观察创面愈合情况及应用免疫组织化学技术检测表皮细胞生长因子/表皮细胞生长因子受体的表达,分析促进骨外露创面愈合的机制。方法:实验于2004-03/09在武汉大学人民医院骨科实验室及武汉大学医学院病理实验室完成。将45只家兔随机分为3组:①肤疾骨宁膏+表皮细胞生长因子组。②肤疾骨宁膏组。③生理盐水组。实验观察60d。结果:肤疾骨宁膏联合表皮细胞生长因子组创面愈合最快,生理盐水组创面愈合最慢(P<0.01)。创面在应用肤疾骨宁膏后,表皮细胞生长因子/表皮细胞生长因子受体表达量逐渐增高,肤疾骨宁膏+表皮细胞生长因子组和肤疾骨宁膏组表皮细胞生长因子表达量在15d分别为0.585±0.028和0.583±0.024,达到高峰,表皮细胞生长因子受体表达量15,22d分别为0.434±0.026,0.427±0.022和0.583±0.024,0.425±0.026,为高峰期,较对照组明显增高,并且高峰提前(P<0.01)。结论:肤疾骨宁膏联合表皮细胞生长因子可有效促进骨外露创面的愈合。     

In Vivo Assessment of a New Method of Pulsatile Perfusion Based on a Centrifugal Pump

The aim of this study was to assess platelet dysfunction and damage to organs after extracorporeal circulation using a pump based on a new method that adds a pulsatile flow to the continuous flow provided by a centrifugal pump. The continuous component of the total flow (2–3 L/min) is created by a Bio‐Pump centrifugal pump, while the pulsatile component is created by the pulsating of an inner membrane pneumatically controlled by an intra‐aortic counterpulsation balloon console (systolic volume of 37.5 mL in an asynchronous way with a frequency of 60 bpm). Six pigs were subjected to a partial cardiopulmonary bypass lasting 180 min and were sacrificed 60 min after extracorporeal circulation was suspended. The hematological study included the measurement of hematocrit, hemoglobin, leukocytes, and platelet function. The new pump did not significantly alter either platelet count or platelet function. In contrast, hematocrit and hemoglobin were significantly reduced during extracorporeal circulation (approximately 5% P = 0.011, and 2 g/dL P = 0.01, respectively). The leukocyte count during extracorporeal circulation showed a tendency to decrease, but this was not significant. In general, the short‐term use of the new pump (4 h) did not cause any serious morphological damage to the heart, lung, kidney, or liver. The results suggest that the hemodynamic performance of the new pump is similar to a conventional centrifugal pump and could therefore be appropriate for use in extracorporeal circulation.