The need for caution with topical anesthesia during endoscopic procedures, as liberal use may result in methemoglobinemia

During upper gastrointestinal endoscopy, topical oropharyngeal anesthesia with lidocaine and/or benzocaine is used routinely by many endodscopists. Although such a practice is usually safe, there have been a number of reports of methemoglobinemia induced by topical anesthesia. Early treatment is extremely important as the development of methemoglobinemia is potentially fatal. Methemoglobinemia should be considered when oxygen desaturation occurs without another explanation. In this case series, we report 4 cases of methemoglobinemia that followed the liberal application of Cetacaine for ERCP. All patients recovered after appropriate treatment but these cases serve to highlight the potential problem, the importance of early recognition and treatment, and the most appropriate treatment options.     

The relationship of human platelet density to platelet age: platelet population labeling by monoamine oxidase inhibition

The relationship between platelet density and platelet age appears to vary between species with relatively few labeling studies in humans reported. In this study, irreversible monoamine oxidase (MAO) inhibitors were used to biochemically label the circulating platelet population in 15 humans. Platelet samples were then isolated during the 15 days after drug ingestion. The platelets were separated by density on continuous linear Percoll gradients and the density distributions were divided into five fractions containing approximately equal numbers of platelets. Baseline MAO activity was strongly correlated with platelet density. Twenty-four hours after a single dose of tranylcypromine, platelet MAO activities in the density subpopulations were reduced to 14% to 17% of the baseline values. During the first five days after inhibition, the rates of recovery of MAO activity (percentage per day) were inversely proportional to platelet density. The recovery rates in the two most dense fractions were initially slow but increased after five days. Percentage recovery of MAO activity in the least dense fraction was significantly greater than the percentage recovery in the most dense fraction on days 2, 3, 5, and 8 (P less than .01, sign test). These results support the hypothesis that normal human platelets show a small increase in density with age, but they do not exclude the additional possibility that human platelet lifespan is positively correlated with platelet density.     

The risk of nursing home admission in three communities

Beginning in 1982, the 3-year incidence of nursing home admission was determined for community-dwelling residents aged 65 and over in East Boston, Massachusetts (4%); New Haven, Connecticut (9%); and Iowa and Washington Counties, Iowa (12%). A common methodology was used to collect baseline risk factor and follow-up data on nursing home admissions among persons in each community as part of the National Institute on Aging's Established Populations for Epidemiologic Studies of the Elderly. A multivariate logistic regression model of baseline risk factors that included the participant's age, race, sex, history of prior admission, ADL limitations, cognitive function, living arrangements, and level of income predicted 80% of the users in each community.     

中国社区肺结核主动筛查循证指南

为实现终止结核病流行策略目标,迫切需要实施更强有力的措施来改善结核病患者的发现和治疗管理,而主动筛查作为实现目标的重要组成部分,旨在确保结核病患者的早期诊断。中国防痨协会结核病控制专业分会和老年结核病防治专业分会与《中国防痨杂志》编辑委员会共同组织专家,在解读吸收世界卫生组织2021年最新指南证据和建议的基础上,补充了后续新发表的文献和我国国内的相关文献和研究证据,结合中国结核病防治实践和研究结果制订了本指南。本指南系统总结了症状筛查、胸部影像学检查、C反应蛋白检测等筛查技术的特点,提出了在肺结核患者密切接触者、既往结核病患者、HIV/AIDS者、老年人、糖尿病患者和高疫情地区的一般人群等社区人群中开展肺结核主动筛查的方式,为国家和各地完善和优化重点人群肺结核主动筛查策略提供循证依据。     

布-加综合征介入治疗护理规范专家共识

【摘要】 为促进布-加综合征（BCS）介入治疗围手术期护理标准化和规范化,保障患者安全,促进患者康复,特制定本共识。本共识以我国BCS的介入治疗临床实践为基础,结合国内外相关文献,就BCS介入治疗的专科护理评估、术中护理配合、疗效评价、术后护理、常见严重并发症及其护理进行了全面阐述,旨在为BCS介入治疗围手术期护理提供指导与参考。     

Slow moving proteinase. Isolation, characterization, and immunohistochemical localization in gastric mucosa

Human gastric mucosa contains three immunochemically distinguishable aspartic proteinases, pepsinogen I (pepsinogen A), pepsinogen II (pepsinogen C, progastricsin), and a nonpepsinogen proteinase also termed slow moving proteinase (SMP). The properties of SMP, and in particular its relationship to another aspartic proteinase, cathepsin D, were examined in this study. Slow moving proteinase and cathepsin D were isolated, respectively, from gastric mucosa and human spleen. Antiserum specific to each proteinase was prepared in rabbits. Rabbit anti-SMP did not recognize cathepsin D, and conversely, anticathepsin D did not react with SMP. Immunohistochemical studies localized SMP to surface epithelial cells in both the fundic and pyloric gland areas of the stomach. In contrast, cathepsin D was found mainly in mononuclear cells in the lamina propria and in parietal cells. Slow moving proteinase exhibited considerably lower Km values for its interaction with two chromogenic substrates than did cathepsin D. An even greater distinction between the two enzymes was found with the protein inhibitor from Ascaris lumbricoides; the activity of SMP was inhibited very strongly, whereas that of cathepsin D was not affected. By sodium dodecyl sulfate-polyacrylamide gel electrophoresis under denaturing conditions, SMP consisted of two subunits with apparent molecular weights of 42,500 and 41,000. The last two properties characterize a less-well-known aspartic proteinase, cathepsin E. We conclude that SMP is not cathepsin D, but that it may be cathepsin E.     

Unicompartmental knee arthroplasty: Is robotic technology more accurate than conventional technique?

BackgroundRobotic-assisted unicompartmental knee arthroplasty (UKA) with rigid bone fixation "can significantly improve implant placement and leg alignment. The aim of this cadaveric study was to determine whether the use of robotic systems with dynamic bone tracking would provide more accurate UKA implant positioning compared to the conventional manual technique.MethodsThree-dimensional CT-based preoperative plans were created to determine the desired position and orientation for the tibial and femoral components. For each pair of cadaver knees, UKA was performed using traditional instrumentation on the left side and using a haptic robotic system on the right side. Postoperative CT scans were obtained and 3D-to-3D iterative closest point registration was performed. Implant position and orientation were compared to the preoperative plan.ResultsSurgical RMS errors for femoral component placement were within 1.9 mm and 3.7° in all directions of the planned implant position for the robotic group, while RMS errors for the manual group were within 5.4 mm and 10.2°. Average RMS errors for tibial component placement were within 1.4 mm and 5.0° in all directions for the robotic group; while, for the manual group, RMS errors were within 5.7 mm and 19.2°.ConclusionsUKA was more precise using a semiactive robotic system with dynamic bone tracking technology compared to the manual technique.     

A pleasant dilemma to have: to treat the HCV patient on the waiting list or to treat post‐liver transplantation?

New and relatively well‐tolerated medications to treat hepatitis C virus (HCV) infection have presented an opportunity for hepatologists to eliminate HCV in liver transplant (LT) candidates prior to transplantation. While concern for causing decompensated liver disease in the sickest subset of pre‐transplant patients makes some clinicians reluctant to offer treatment, we believe that several advantages of early HCV eradication appear to shift the debate in favor of using anti‐HCV agents before LT. There are encouraging safety data for new HCV medications in cirrhotic patients, and given the limited supply of donor livers available, delaying or possibly preventing the need for LT by treating HCV can offer significant benefit. Post‐LT, making immunosuppression management easier as well as avoiding both extrahepatic manifestations of HCV (e.g., diabetes mellitus and kidney disease) and the dilemma of distinguishing post‐transplant viral recurrence from allograft rejection makes earlier treatment of HCV especially appealing to clinicians. Furthermore, retrospective data have demonstrated a mortality benefit among HCV patients who are free of the virus at the time of LT. This article explores arguments for and against treating HCV in patients on the transplant list.