中西医联合治疗难治性肺结核的疗效观察

目的观察中西药联合治疗难治性肺结核的疗效。方法选择单纯西药治疗12个月以上疗效欠佳的病例,分为联合治疗组54例(A组)对照组54例(B组)观察两组治疗效果。结果 A组在痰菌阴转,空洞关闭,病灶吸收,症状控制等多方面的疗效结果均高于B组。结论采用中西医结合治疗难治性肺结核,治愈率高,值得临床推广。     

Synthesis of Nα-Fmoc protected derivatives of S-(2,3-dihydroxypropyl)-cysteine and their application in peptide synthesis

Acylated derivatives of S-(2,3-dihydroxypropyl)-cysteine (S-glycerylcysteine) form the N-terminus of structural and functional proteins of bacterial origin. Synthetic lipopeptides containing tripalmitoyl-S-glycerylcysteine are derived from bacterial lipoprotein and constitute potent immunoadjuvants activating both B-lymphocytes and macrophages. There is increasingly interest in conjugates consisting of tripalmitoyl-S-glycerylcysteine linked to appropriate viral and bacterial antigens, because of their capability of inducing antigen specific antibodies and T-helper and T-killer cell specific immune responses. A new convenient synthetic pathway for the preparation of these tripalmitoyl-S-glycerylcysteinyl peptides is described. The use of N_α-Fmoc-protected S-(2,3-dihydroxypropyl)-cysteine and its O,O′-bis acylated derivatives for the synthesis of triacyl-S-glycerylcysteinyl, O,O′-bis-acyl-5-glycerylcysteinyl and S-glycerylcysteinyl peptides of high diastereomeric purity by solid phase peptide synthesis or synthesis in solution is demonstrated.     

Atrial Vulnerability in Patients with Paroxysmal "Lone" Atrial Fibrillation

Little is known about the electrophysiological properties of the atrium predisposing to paroxysmal atrial fibrillation (AF), especially in patients without structural heart disease. This study was conducted to analyze intraatrial conduction, atrial refractoriness, and arrhythmia inducibility in patients with lone paroxysmal AF. An electrophysiological study was performed in 24 patients with a documented history of lone paroxysmal AF but in sinus rhythm at the time of the electrophysiological study. Twelve patients without any history of atrial arrhythmias served as controls. The patients with lone paroxysmal AF showed a significant prolonged local conduction time S1A1 (70 ± 21 ms vs 36 ± 12 ms, P < 0.0001), a lack of rate adaptation of the functional refractory period (FRP changes/cycle length changes < 10% in 15 of 24 patients with lone paroxysmal AF vs 1/12 controls, P = 0.002) and a higher incidence of inducible AF with only one extrastimulus (13/24 vs 0/12, P = 0.0014). The total P wave duration in the surface ECG (89 ± 14 ms vs 83 ± 8 ms, P = 0.15), the intraatrial conduction time (36 ± 14 ms vs 28 ± 8 ms, P = 0.07), the presence of a fragmented atrial electrogram (16/24 vs 7/12, P = 0.62), the absolute value of the effective refractory period (204 ± 28 ms vs 212 ± 23 ms, P = 0.42), and the vulnerability index (3.0 ± 1.5 vs 3.6 ± 1.5, P = 0.26) were not statistically different between the two groups. The presence of a prolonged (> 50 ms) S1A1 and/or the presence of a lack of rate adaptation of the FRP and/or the presence of inducible AF identified patients with spontaneous lone paroxysmal AF with a sensitivity of 96%, a specificity of 67%, a positive predictive value of 85%, and a negative predictive value of 89%. In patients with lone paroxysmal AF. the electrophysiological study using conventional techniques allows not only to detect AF inducibility using a nonaggressive protocol, but also to reveal several electrophysiological abnormalities related to the atrial substrate itself. This atrial vulnerability may explain the high incidence of recurrences in patients with lone paroxysmal AF.     

The cost of blood: multidisciplinary consensus conference for a standard methodology

Prior attempts to account for the cost of blood have varied in economic perspective, methodology, and scope and may have underestimated both direct and indirect costs associated with transfusions. To devise a comprehensive and standardized methodology for the United States that will improve upon existing estimates, a panel of experts in blood banking and transfusion medicine was assembled and participated in consensus deliberations using modified Delphi methods. As a first step, a process-flow model that describes all the major steps involved in collecting, processing, and transfusing blood such as donor recruitment and follow-up of transfusion sequelae was constructed. Next, interdependencies were outlined and detailed cost elements within each step were itemized. The relative importance of each element was rated. Personnel, screening for infectious agents, information systems, laboratory evaluations, management of transfusion reactions, and equipment were ranked as the most important factors to capture but, in an effort to be all-inclusive, even minor elements were included. This consensus model is broad-based and should serve societal, provider, and payer perspectives for future cost studies. Recognizing the limitations of process-flow models, the next iteration will use an activity-based approach to more fully account for the cost of blood than present estimates.     

应用优先图像强制压缩传感算法降低低剂量MDCT腹部影像噪声的研究

目的评价优先图像强制压缩传感算法(PICCS)在低剂量MDCT噪声降低方面的价值及其影像质量。材料与方法本研究获机构审查委员会批准(免除知情同意书)并符合     

Importance of Tachycardia Cycle Length for Differentiating Typical Atrial Flutter from Scar‐Related in Adult Congenital Heart Disease

Background: Radiofrequency catheter ablation (RFCA) for intraatrial reentrant tachycardia (IART) in congenital heart disease (CHD) remains difficult. Methods: Thirty‐four consecutive adult patients (age, 37.6 ± 12.8 years; male, 21) with previously repaired CHD and IART underwent an electrophysiological study and RFCA. CHD included atrial septal defect (ASD, n = 14), tetralogy of Fallot (n = 11), ventricular septal defect (n = 4), pulmonary atresia (n = 2), atrioventricular septal defect (n = 1), transposition of the great arteries (n = 1), and double‐outlet right ventricle (n = 1). Results: Duration of CHD repair to IART onset was 19.1 ± 8.5 years. Thirty and four patients had single‐ and double‐loop reentrant tachycardia, respectively. Among the total of 38 IARTs, which were mapped, 22 (57.9%) and 13 (34.2%) IARTs were cavotricuspid isthmus (CTI)‐dependent atrial flutter (AFL) and scar‐related AFL, respectively. Typical AFL electrocardiography findings including definite sawtooth appearance in inferior leads and positive F wave in lead V1 were observed in only 12 of 21 patients (57.1%) with CTI‐dependent AFL. CTI‐dependent AFL had a significantly longer tachycardia cycle length (TCL) than scar‐related AFL (267.6 ± 34.4 ms and 235.9 ± 37.0 ms, respectively; P = 0.031). TCL > 250 ms had 79% sensitivity as the cutoff value for differentiating CTI‐dependent from scar‐related AFL. The acute success rates of RFCA in CTI‐dependent and scar‐related AFLs were 85.7% and 90.0%, respectively. The recurrence rates in CTI‐dependent and scar‐related AFLs were 11.1% and 11.1%, respectively, during a follow‐up of 21.2 ± 28.3 months. Conclusions: CTI‐dependent AFL was the most common IART in adult patients with repaired CHD and was easily manageable by RFCA. TCL might help to differentiate CTI‐dependent AFL from other IARTs. (PACE 2012;35:1338–1347)     

The clinical picture of ectasia of the intracerebral arteries

Thirty-one patients with ectasia of intracranial arteries were studied. The carotid system was more frequently involved than the vertebrobasilar. The condition is relatively rare and usually occurs with other vascular disease. Ectasia presents with a variety of neurological symptoms, amongst which visual disorders are common. The overall mortality was 52%, but the prognosis was appreciably worse for the vertebrobasilar group, probably because of a higher incidence of compression of surrounding neural structures. Defects in the internal elastic lamina, with or without associated atheroma, are often found in the affected arteries.     

The changing prevalence of autistic disorder in a Welsh health district

A prevalence study of autistic disorder(AD) in childhood was undertaken in a Welsh health district as part of a needs' assessment exercise. The study population were all children resident in the district with dates of birth between 1977 and 1988. Children were identified after a trawl of service providers in health and education and diagnosis was confirmed at a multidisciplinary assessment. An increase in prevalence was found, an observation that has been made in other parts of the world. The increase in prevalence, whether real or administratively apparent, has major implications for service providers in health, education, and social care, in that a larger number of children are being recognised as having a triad of impairments which requires very specific interventions and support from all three agencies.