Is Gd-DTPA required for routine cranial MR imaging?

Gadopentetate dimeglumine (gadolinium diethylenetriaminepentaacetic acid [DTPA]) was administered prospectively to 500 consecutive children and adults referred for routine cranial magnetic resonance (MR) imaging over a 4-month period. Pre- and postcontrast images were blindly and independently interpreted by two experienced neuroradiologists. Specific criteria were provided to the readers to define objectively when contrast material enhancement (or lack thereof) would be considered "radiologically helpful." Contrast-enhancing lesions were observed in 99 cases (20%). In only 15 cases (3%) did Gd-DTPA permit detection of lesions not also apparent on the precontrast studies. Contrast enhancement was considered radiologically helpful in 74 of the 99 cases. Lack of enhancement was considered helpful in 112 of the 500 cases (22%). Factors that may indicate increased usefulness of Gd-DTPA include increased patient age, definite lesion seen at computed tomography or precontrast MR imaging, prior craniotomy for tumor, and clinically documented systemic or central nervous system disease. Gd-DTPA should probably be used routinely for cranial MR imaging in most patients, except, perhaps, children and young adults with normal precontrast images.     

婴儿心肺转流20例无死亡的灌注体会

0　引言　1997-03/1998-07,我科曾对70例小于3岁有先心病患儿进行体外循环下心内畸形矫治,其中小于1岁婴儿20例无1例死亡.现将20例婴儿患者的体外循环预充及转流体会总结如下.1　对象和方法1.1　对象　婴儿20(男11,女9)例.年龄2～12mo.3mo3例,4～6mo6例,7～9mo6例,12mo5例.体质量3～7.5(平均5.7)kg.病种包括:室缺10例,室缺合并肺动脉高压4例,室缺合并肺动脉高压和动脉导管未闭2例,法乐三联症1例,法乐四联症3例.1.2　方法　1体外循环预充:血液稀释度为HCT20%,不足部分预充新鲜库血,一般晶体醋酸钠平衡盐250～400mL,血浆100～150mL或200g.L…     

Prospective study of the incidence of diarrhoea and prevalence of bacterial pathogens in a cohort of Vietnamese children along the Red River.

We prospectively studied diarrhoea incidence among 1655 children < 5 years of age in northern Vietnam for 1 year using primarily passive surveillance. Standard culture methods were used to detect bacterial pathogens. Overall 2160 cases occurred (13 cases/child per year). Peak rates of diarrhoea occurred in children < 12 months old. Rates ranged from 3.3 cases/child per year in children < 1 year old, to 0.7 cases/child per year in 4-year-olds. Campylobacter, shigella and enterotoxigenic Escherichia coli were most commonly isolated. Rates detected by active surveillance were about twice those detected passively. S. flexneri was the most common shigella serogroup (65 %). S. flexneri serotypes 6, 4, 1 and Y were most common, but 40% were untypable using commercial antisera. The data illustrate important regional differences in pathogen prevalence and shigella serotype distribution. Shigella vaccine development strategies, commonly targeting S. flexneri 2a, S. sonnei and S. dysenteriae 1, will have little impact on diarrhoea rates in Vietnam.     

大连理工大学图书馆员的人格因素和职业现状分析

目的:通过对图书馆员的人格因素和职业现状分析,为图书馆的人力资源管理提供参数。方法:于2005-06/08纳入大连理工大学伯川图书馆馆员72人作为人格测试组,男7人,女65人;同时纳入2005-07前在职的全部馆员122人作为职业现状分析组,男26人,女96人。采用国际公认的卡特尔16种人格因素问卷,对人格测试组进行人格测试。问卷从16个相对独立的人格维度对人进行描绘,全套测试题共187题,每题设有a,b,c3种可供选择的答案。将测试结果输入心理测试软件系统,给出粗分和标准分,再运用软件进行数据的统计分析。对职业现状分析组的全体馆员进行了性别,年龄结构,男女馆员在各工作部门的分布,及馆员的学历构成,技术职称和领导职务的担任比例统计分析。观察人格测试组卡特尔16种人格因素问卷人格类型的次元因素和综合个性应用评价分数,并对全体馆员的自然状况列表进行统计分析,分析其职业现状。结果:发放卡特尔16种人格因素问卷72份,回收完整问卷46份,回收率63.9%,有效率100%。最终人格测试组46人进入结果分析,男5人,女41人。职业现状分析组122人,全部进入结果分析。①人格测试组聪慧性、幻想性、自律性均高于全国专业技术人员常模,差异有显著性意义(9.74±1.22;8.88±1.22;13.11±2.36,11.83±1.25;13.89±2.59,12.40±1.47;t=4.780,3.676,3.901,2.783,P<0.001～0.01)。被试馆员怀疑性和紧张性低于全国专业技术人员常模,差异有显著性意义(9.39±2.85,10.56±1.57;9.76±3.72,11.19±1.65;t=-2.783,-2.606,P<0.01,0.05)。②女性图书馆员占总人数的78.7%,男性图书馆员在年龄结构上处于年龄段的两端,在生理上处于成年早期(30.7%)和晚期(38.4%);女性馆员的年龄集中于30～50岁的年龄段(86.3%)。③男馆员在综合办公室、自动化部和技术服务部的人数分布方面占据优势地位(38.4%,11.5%,11.5%);而女性馆员集中于期刊咨询部、文献建设部、流通阅览部和回溯建库等信息服务咨询部门(24%,15.6%,40.6%,4.2%)。④男馆员在获得博士、双学士、学士学位,及本科、中专学历方面的人数比例大于女性馆员,而女性馆员在获得硕士学位及大专和较低学历方面所占的比例大于男性馆员。⑤男性馆员在高级技术职称和馆级领导高端决策层占优势,在初级和较低技术职称中占比例较大;女性馆员在中级技术职称中级领导层上占比例大于男性馆员。结论:图书馆员女性化,而男性馆员在知识结构、职称、高端决策层领导职务的担任和承担高技术性工作方面的整体水平优于女性馆员。更应着重分析女性图书馆员的生理、心理特点,人格因素和职业特征,进行人力资源的优化组合。     

Thunderclap headache: is it migraine?

In a prospective study, 14 out of 49 patients presenting to a Regional Neurosurgical Unit with sudden headache suggestive of subarachnoid haemorrhage had normal CSF and a normal CT scan: it did not prove possible, on clinical grounds alone, to distinguish these from those that had bled. We have now followed all these patients for a minimum of 18 months. Only one has had no further headache, 4 have had musculoskeletal pain, 5 psychogenic pain, and 4 migraine type symptoms. None went on to have an unequivocal subarachnoid haemorrhage, and we conclude that angiography cannot be justified in patients with this type of "thunderclap headache".     

Blood warming: current applications and techniques

Active blood warming is a recent practice and arises out of conflicting needs. On the one hand, the safety and preservation of blood require refrigerated storage and delivery up to the moment of transfusion. On the other hand, modern methods of very rapid transfusion in resuscitation would cause clinically dangerous hypothermia if unmodified, ice-cold blood were to be so transfused. These needs must be reconciled in the interest of adequate patient care--hence the need for blood warming. Nevertheless, blood warming creates risks of its own and should not be used without justifying clinical indications. Within limits that extend somewhat above normal body temperature, the application of heat does no harm to stored RBC, a fact that is not reflected in current standards for blood warmers. Bearing in mind the human tendency to "stretch" standards and the fallibility of mechanical devices, caution is always wise. But perhaps the time has come for reconsideration of the present upper limit of 38 degrees C. Many varieties of blood warmers are available in the US, but none at this time is based on electromagnetic activity. The most common systems now in use are in-line warmers, most of which are not adequate for the type of rapid-transfusion systems currently available. Countercurrent in-line blood warmers and the method of rapid warm saline admixture can both be used successfully for rapid, massive transfusions. Blood warming is seldom necessary or desirable for elective transfusions at conventional rates, even for patients with cold autoagglutinins.     

Mapping of monoclonal antibodies to human factor IX

We used recombinant DNA techniques to map a panel of six monoclonal antibodies (MoAbs) to regions of the human factor IX molecule. A-2 maps to 17 amino acids at the amino terminus of the heavy chain of IXa; 2D5, an inhibitor of clotting, is defined to 36 amino acids of the first EGF- like domain of human factor IX. A-4, A-5, C10D, and FXC008 all map to a region of the heavy chain containing amino acids 180 through 310, suggesting an immunodominant site. FXC008 has been reported to interfere with binding of factor IXa to factor VIII:Ca.     

Thrombopoietin induces tyrosine phosphorylation and activation of the Janus kinase, JAK2

Thrombopoietin (TPO) is a recently characterized growth and differentiation factor for megakaryocytes and platelets that exerts its effects via the receptor, c-MpI. This receptor is a member of the hematopoietin receptor superfamily and is essential for megakaryocyte maturation; however, the molecular mechanisms of TPO and c-MpI action have not been elucidated. Recently, the Janus kinases have emerged as important elements in signaling via this family of receptors. In this report, we show that, in the M07e megakaryocytic cell line, which expresses c-MpI and proliferates in response to TPO, TPO induces phosphorylation of a number of substrates between 80 and 140 kD. Specifically, we show that stimulation with TPO induces the rapid tyrosine phosphorylation of a 130-kD protein that we identify as the Janus kinase, JAK2. However, no detectable tyrosine phosphorylation of JAK1, JAK3, or TYK2 was observed. TPO also induced activation of JAK2 phosphotransferase activity in vitro. Taken together, these data indicate that JAK2 likely plays a key role in TPO-mediated signal transduction.     

Heterogeneity of the T-cell receptor delta gene indicating subclone formation in acute precursor B-cell leukemias

Precursor B-cell acute lymphoblastic leukemias (B-ALLs) have been shown to be oligoclonal at the Ig heavy-chain (IgH) gene level in up to 40% of cases by Southern blot hybridization. In contrast, oligoclonality as deduced from diversity of T-cell receptor (TcR)-delta gene rearrangements of the immature types (ie, V delta 2-D delta 3, D delta 2-D delta 3) has not been reported, so far. We detected oligoclonality characterized by the coexistence of different junctional regions of identical V delta 2-D delta 3 rearrangements in four childhood precursor B-ALLs. No variation was found in the IgH gene status. Therefore, we define these populations as subclones. Two leukemias displayed the variants in an unequal proportion. In the other two leukemias, for which similar quantities of the coexisting rearrangements were detected, single cell-nuclei polymerase chain reaction (PCR) showed two separate leukemic populations. Subclone formation could not be demonstrated by Southern blot hybridization, but was detectable after PCR amplification of the V delta 2-D delta 3 rearrangement and separation by polyacrylamide gel electrophoresis. The variants arose independently from each other, as deduced from their individual sequences. Using subclone-specific oligonucleotides for hybridization to amplified DNA obtained at diagnosis and during follow- up from bone marrow samples, we demonstrate, (1) specificity of all subclone-deduced probes, (2) that one residual leukemic cell can be detected in 10(4) to 10(5) normal mononuclear cells in a semiquantitative assay, and (3) that none of the subclones persisted after induction therapy. We propose that in a leukemic cell population, TcR-delta gene diversity arises after rearrangements of the IgH genes resulting in apparent clonality at the IgH gene level. However, cells are oligoclonal, if the TcR-delta gene rearrangements are considered. As various subclones may respond differently to chemotherapy, they may hamper the detection of minimal residual disease. Therefore, we use all subclone-specific oligonucleotides for hybridization to amplified DNA from follow-up samples.     

Genetic defect responsible for the dysfunctional protein: factor IXLong Beach

DNA sequence analysis of the gene coding for the variant protein, factor IXLong Beach (FIXLB), has identified a transition mutation in an otherwise normal factor IX (FIX) gene. Genomic DNA clones spanning 35 kilobase (kb) pairs of the FIXLB gene were isolated. A gene analysis strategy that specifically characterized exons and their flanking intron sequences predicted the entire amino acid sequence of FIXLB. A thymine to cytosine transition causes the substitution of a threonine codon (ACA) for an isoleucine codon (ATA) in exon VIII of the FIXLB gene. This mutation results in an amino acid substitution at residue 397 of the FIX zymogen and the phenotypic display of hemophilia-B. Previous studies revealed that activated purified FIXLB (FIXaLB) had normal Ca2+, phospholipid, and factor VIIIa binding characteristics. However, FIXaLB activated factor X or factor VII (with their cofactors Ca2+ and phospholipid) at significantly reduced rates, suggesting that the defect in FIXaLB lies near or within the catalytic triad of the FIX heavy chain. Identification of an amino acid substitution near the carboxy-terminus of the FIXaLB heavy chain supports the earlier characterization of this variant protein. Moreover, our data identify a residue in the catalytic domain of FIXa essential for normal function.