激素避孕剂对泪腺功能的影响

目的：探究不同类型的激素类避孕剂对于泪腺功能及泪膜的影响。
　　方法：前瞻性随机对照试验。选取60位来自马来西亚贝尼苏夫大学与法尤姆大学医学院的患者随机分为6组(每组10位患者)。第一组：口服复合避孕药;第二组：每月注射复合避孕剂(Mesocept);第三组：注射甲羟孕酮(Depo-Provera);第四组：仅服用黄体酮药片;第五组：皮下埋植(Implanon);第六组：对照组。所有患者均进行全面妇科和眼科检查,包括 Schirmer 试验和泪膜破裂时间,随访至少3mo。
　　结果：所有患者的平均年龄为31.03依6.97岁。年龄和孕产次各组之间差异无统计学意义。结果显示：口服复合避孕药干眼患病率最高,其次是每月注射复合避孕剂、注射甲羟孕酮、仅服用黄体酮药片和皮下埋植。对照组无干眼患者。
　　结论：与仅含有孕激素的避孕方法相比,同时含有雌激素和孕激素的避孕方法导致干眼的可能性更大。     

Utility of CT‐cisternogram for radiosurgery in trigeminal neuralgia: A not‐to‐be forgotten technique

Radiosurgery (RS) is a well‐established ablative therapy for trigeminal neuralgia (TGN). Successful RS requires the delivery of an extremely high dose of radiation to a small cisternal portion of the nerve, which lies amidst critical structures. This study describes the utility of CT‐cisternogram in RS targeting for TGN. We report on patients with TGN who required CT‐cisternogram for target identification for CyberKnife (CK) RS at our institution between September 2010 and April 2015. CT‐cisternogram is a well‐tolerated procedure that adds useful information to RS planning. Illustrative cases with complex anatomy and MRI artifacts related to postoperative changes and Teflon implant are described. CT‐cisternogram is a complementary imaging modality that is useful in some patients, for RS target delineation.     

Capecitabine vs continuous infusion 5-FU in neoadjuvant treatment of rectal cancer. A retrospective review

Background Standard therapy for locally advanced rectal cancer (LARC) is concurrent neo-adjuvant chemo-radiation using infusional 5-fluorouracil (CIV-5-FU). Capecitabine (CAP) offers a convenient oral replacement for CIV-5-FU. There is no randomized trial comparing infusional 5-FU to capecitabine. We retrospectively compared the safety and efficacy of CAP-based regimens with well-established CIV-5-FU-based regimens in LARC. Materials and methods We collected published data on 542 patients treated on either CIV-5-FU (197) or CAP (345) with concurrent radiation (external radiation treatment, XRT) for LARC. This included Phase I or II studies published or available from Pubmed. Safety was assessed by determining proportion of patients who experienced grade III/IV adverse effects. Efficacy was assessed by determining pathological complete response (pCR). Chi-square tests were used to compare the two regimens. A P value less than 0.05 was considered statistically significant. Statistical tests were further corrected for multiplicity using the method of Benjamini and Yekutieli (Ann Stat, 29(4):1165–1188, 2001). Results pCR was significantly higher in patients getting CAP vs CIV-5-FU (25 vs 13%; P = 0.008,.P _adj = 0.034). Both regimens were generally well tolerated. There was no grade IV toxicity reported. Grade III hand foot syndrome was more common in the CAP group, and grade III diarrhea was more common in the CIV group. Conclusions CAP when compared to CIV seems to have superior efficacy with reasonable toxicities. It is reasonable to treat LARC with CAP + XRT.     

NT-proBNP levels, echocardiographic findings, and outcomes in breathless patients: results from the ProBNP Investigation of Dyspnoea in the Emergency Department (PRIDE) echocardiographic substudy.

AIMS: The objective of this study was to determine the integrative utility of measuring plasma NT-proBNP levels with echocardiography in the evaluation of dyspnoeic patients. METHODS AND RESULTS: Of 599 emergency department patients enrolled in a clinical study of NT-proBNP at a tertiary-care hospital, 134 (22%) had echocardiographic results available for analysis. Echocardiographic parameters correlating with NT-proBNP levels were determined using multivariable linear-regression analysis. Independent predictors of 1-year mortality were determined using Cox-proportional hazard analysis. Independent relationships were found between NT-proBNP levels and ejection fraction (P = 0.012), tissue Doppler early and late mitral annular diastolic velocities (P = 0.007 and 0.018), right ventricular (RV) hypokinesis (P = 0.006), and tricuspid regurgitation severity (P < 0.001) and velocity (P = 0.007). An NT-proBNP level <300 pg/mL had a negative predictive value of 91% for significant left ventricular systolic and diastolic dysfunction. Overall 1-year mortality was 20.1% and was independently predicted by NT-proBNP level [HR 8.65, 95% confidence interval (CI) 2.7-27.8, P = 0.0003], ejection fraction (HR 0.95, 95% CI 0.91-0.99, P = 0.009), RV dilation (HR 2.98, 95% CI 1.05-12.8, P = 0.04), and systolic blood pressure (HR 0.97, 95% CI 0.96-0.99, P = 0.01). CONCLUSION: NT-proBNP levels correlate with, and provide important prognostic information beyond, echocardiographic parameters of cardiac structure and function. Routine NT-proBNP testing may thus be useful to triage patients to more timely or deferred echocardiographic evaluation.     

Quality of Care of Medicare Beneficiaries with Acute Myocardial Infarction: Who Is Included in Quality Improvement Measurement?

OBJECTIVES: To determine the proportion of older patients hospitalized with acute myocardial infarction (AMI) incorporated in a commonly used set of AMI quality indicators. DESIGN: Retrospective analysis of a medical record database. SETTING: Nongovernmental U.S. acute care hospitals. PARTICIPANTS: Medicare patients hospitalized for AMI between January 1994 and February 1996. MEASUREMENTS: Proportion of patients aged 65 and older classified as ideal candidates (without absolute or relative contraindications) for six Centers for Medicare & Medicaid Services AMI quality indicators: aspirin (admission, discharge), beta-blocker (admission, discharge), angiotensin-converting enzyme (ACE) inhibitors at discharge, and time to reperfusion therapy. RESULTS: Of the 149,996 patients eligible for admission therapies, 10.1% were ideal candidates for reperfusion therapy, 65.0% for aspirin, and 34.7% for beta-blockers. Of the 116,919 patients eligible for discharge therapies, 47.7% were ideal candidates for aspirin, 17.6% for beta-blockers, and 15.2% for ACE inhibitors. More than one-quarter (26.8%) of all patients were ineligible for any of the six quality indicators; this proportion increased with age, ranging from 23.7% of patients aged 65 to 69 to 30.2% of patients aged 85 and older. CONCLUSION: A substantial proportion of older patients were not included in AMI process quality measurement, with the proportion excluded higher in successively older age groups. The data highlight the need for additional research to determine effective treatment strategies for patients for whom the evidence base for clinical decision-making remains weak.     

Compliant 3D frameworks instrumented with strain sensors for characterization of millimeter-scale engineered muscle tissues

Tissue-on-chip systems represent promising platforms for monitoring and controlling tissue functions in vitro for various purposes in biomedical research. The two-dimensional (2D) layouts of these constructs constrain the types of interactions that can be studied and limit their relevance to three-dimensional (3D) tissues. The development of 3D electronic scaffolds and microphysiological devices with geometries and functions tailored to realistic 3D tissues has the potential to create important possibilities in advanced sensing and control. This study presents classes of compliant 3D frameworks that incorporate microscale strain sensors for high-sensitivity measurements of contractile forces of engineered optogenetic muscle tissue rings, supported by quantitative simulations. Compared with traditional approaches based on optical microscopy, these 3D mechanical frameworks and sensing systems can measure not only motions but also contractile forces with high accuracy and high temporal resolution. Results of active tension force measurements of engineered muscle rings under different stimulation conditions in long-term monitoring settings for over 5 wk and in response to various chemical and drug doses demonstrate the utility of such platforms in sensing and modulation of muscle and other tissues. Possibilities for applications range from drug screening and disease modeling to biohybrid robotic engineering.

Tissue-on-chip (TOC) technologies, also known as organ-on-chip or microphysiological systems, can recapitulate native tissue environments in vitro. These engineered platforms can be used for research in drug discovery, disease development, and regenerative medicine as alternatives to animal and traditional cell culture models (1). Recent reports describe TOC platforms that capture certain essential features of the lung, heart, liver, and brain (2–7). A frontier is in the development of architectures that mimic the three-dimensional (3D) layouts of native tissues, with the ability to monitor and control natural biological and physiological processes across a broad range of electrical, biochemical, and mechanical cues (8, 9). Three-dimensional engineered tissues can reproduce essential structural and functional features of natural biological systems with much greater relevance to living organisms than traditional two-dimensional (2D) cell cultures. Most existing TOC platforms adopt simple planar geometries, due partly to the limited ability to build functional 3D architectures as scaffolds and functional interfaces. While advances in flexible electronics allow for devices in the form of patches (4, 10) or meshes (11–13) that can roll or fold to interface with surfaces of engineered tissues, challenges remain in creating deterministic 3D electronic scaffolds as interfaces to engineered thick tissues in a controlled, 3D spatiotemporal manner. Specific challenges are in precisely defining the 3D locations and/or spatial arrangements of functional electronics for accurate monitoring and regulation of tissue functions. Recent efforts toward these goals include the development of 3D multifunctional electronic scaffolds formed by mechanically guided assembly, as demonstrated in the recording of extracellular potentials of small dorsal root ganglion neuron networks and cardiac cell cultures formed on 3D scaffolds (14, 15) and in electrical stimulation and drug release (15).These technologies offer promising avenues for biological research, but they are not, however, designed for interfaces to grown 3D tissues, nor do they provide mechanical support or sensing of forces or displacements of relevance to smooth, skeletal, or cardiac muscle constructs. Skeletal muscle, in particular, is an interesting target as the most abundant tissue in the human body, comprising ∼40% of the total mass (16). Skeletal muscle-on-chip platforms are important in the study of Duchenne muscular dystrophy disease, and they offer potential for drug screening in this and other contexts (17–19). In addition, 3D engineered skeletal muscles under electrical and optical control can serve as biohybrid actuators in soft robotics for walking, swimming, or pumping functions (20–22). Characterization of skeletal muscle tissue contractility typically relies on image-based methods to monitor motions against soft structures such as elastomeric pillars or hydrogel skeletons (6, 17, 18, 20, 23–26). Mechanical models based on classic beam theories connect these motions to forces. Uncertainties in the constitutive properties of the materials and the geometries of the structures, together with limits in imaging resolution, video frame rate, and imaging processing techniques, contribute to inaccuracies in the measurements.Here, we introduce a class of microfabricated 3D frameworks that can be created in precisely engineered shapes and geometries as mechanical interfaces to 3D skeletal muscle tissues for precise measurements of the spatial and temporal contractile forces associated with optical stimulation under a wide range of conditions. These systems exploit recent advances in mechanically guided assembly techniques to form compliant, 3D frameworks instrumented with strain sensors that connect to external control electronics. A key feature of the engineering approach is that it is compatible with well-developed planar electronic, optoelectronic, photonic, and microelectromechanical systems. The shape-matched 3D geometries and mechanically compliant layouts of these frameworks enable intimate contact and stable mechanical coupling to the tissues of various 3D geometries. Measurements of the contractile forces generated by 3D optogenetically active muscle rings and comparisons with results of conventional optical microscopy demonstrate the utility of these technologies in 3D tissue engineering.