Computed tomography fluoroscopy‐guided chemical lumbar sympathectomy: Simple,safe and effective

Demographic, clinical and laboratory data were retrospectively collected from records of 146 cases of CT fluoroscopy‐guided chemical lumbar sympathectomy for the palliation of inoperable peripheral vascular disease (PVD) between January 1997 and August 1999. Of these, 16% had claudication, 39% had rest pain and 44% had ischaemic ulcers or gangrene. Seventy‐three percent of elective cases were outpatients. At 3 months, 27 cases were lost to follow up, leaving 119 cases. Within 3 months, improvement, defined as doubling of the walking distance, cessation of rest pain or healing of ulcers, occurred in 30.3% of cases. No change was observed in 45.4% of cases and 24.3% of cases deteriorated. Patients with ulcers or gangrene had significantly poorer results than those without any ischaemic lesions, as only 19% versus 39% of patients improved (P < 0.05). The presence of hypertension, diabetes mellitus, hyperlipidaemia and smoking had no value in predicting clinical outcome (P > 0.05). There were no major complications noted. CT fluoroscopy‐guided chemical lumbar sympathectomy is safe and effective, with a complication rate of less than 1%, and efficacy of at least 30% measured within 3 months. It is a simple and minimally invasive procedure, easily performed on an outpatient basis. CT fluoroscopy‐guided chemical lumbar sympathectomy should be considered for all patients in the early stages of inoperable PVD.     

Clinical prospective study of biochemical markers and evoked potentials for identifying adverse neurological outcome after thoracic and thoracoabdominal aortic aneurysm surgery

Background. Neurological deficit after repair of a thoracicor thoracoabdominal aortic aneurysm (TAA/TAAA) remains a devastatingcomplication. The aim of our study was to investigate the clinicalvalue of biochemical markers [S-100B, neurone-specific enolase(NSE) and lactate dehydrogenase (LD)], evoked potentials andtheir combinations for identifying adverse neurological outcomeafter TAA/TAAA surgery. Methods. From 69 patients, cerebrospinal fluid and blood samplesfor biochemical analysis were drawn after the induction of anaesthesia,during the cross-clamp period, 5 min, 2, 4, 6, 8, and 19 h,respectively, after reperfusion. In addition, continuous perioperativerecording of motor-evoked potentials after transcranial electricalstimulation (tcMEP) and somatosensory-evoked potentials wascarried out. Furthermore, neurological examinations were performed. Results. In patients with a defined decrease in lower extremitytcMEP during the cross-clamp period, we found that combinationsof the serum concentrations of S-100B and tcMEP ratios at 4,6, and 8 h after reperfusion had a positive and negative predictivevalue of 100% in predicting adverse neurological outcome afterTAA/TAAA surgery. Furthermore, combinations of the serum concentrationsof S-100B and NSE or LD at 19 h after reperfusion had both apositive and negative predictive value of 100% in identifyingpatients with adverse outcome after TAA/TAAA repair. Conclusions. TcMEP monitoring during TAA/TAAA surgery seemsto be an effective but not completely sufficient guide in ourprotective multi-modality strategy. Combinations of the serumconcentrations of S-100B and tcMEP ratios during the early reperfusionperiod might be associated with adverse neurological complications.Furthermore, biochemical markers could detect central nervoussystem injury on the first postoperative day and may have prognosticvalue.     

Duration of breastfeeding and breastfeeding problems in relation to length of postpartum stay: a longitudinal cohort study of a national Swedish sample

AIM: To investigate the association between length of postpartum stay and duration of breastfeeding and breastfeeding problems, with special focus on early hospital discharge. METHODS: Swedish-speaking women were recruited from all antenatal clinics in Sweden during 3 wk evenly spread over 1 y in 1999 to 2000. In total, 3293 women (71% of those who were eligible) consented to participate in the study. Data were collected by questionnaires in early pregnancy, 2 mo and 1 y postpartum, and from the Swedish Medical Birth Register. For the purpose of this study, only data from the 2709 women (82%) who filled in the question about length of stay in the 2-mo questionnaire were analysed. Women were divided into six groups according to length of postpartum stay (day 1: < 24 h to day 6: > or = 120 h). RESULTS: The median duration of any breastfeeding was 7 mo in women discharged on day 1, and 8 mo in women discharged on any of the following days; a non-significant difference (p = 0.66). Besides hospital policies regarding length of stay (residential area) and number of domiciliary visits, early discharge was associated with the following maternal characteristics, which could be divided into three categories: (1) older, multipara, many children; (2) positive experience of the first breastfeeding after birth; (3) low education, economic problems, smoking, lack of support from partner. Late discharge was associated with operative delivery, preterm birth and low infant birthweight. When these factors were controlled for by Cox regression analysis, no statistical differences were found between the six groups in the relative risk of discontinuing to breastfeed. Breastfeeding problems, such as engorgement and mastitis, did not differ, but women discharged on day 6 or later had fewer problems with sore or cracked nipples during the first week and more problems 4-8 wk postpartum. CONCLUSION: Maternal characteristics may be more important predictors of the duration of breastfeeding than length of stay in hospital after the birth. The effect of domiciliary support needs further research.     

Growth under privileged conditions of healthy Swedish infants exclusively breastfed from birth to 4-6 months: a longitudinal prospective study based on daily records of feeding

Aim: In most studies the methodology used to study growth in relation to breastfeeding patterns cannot ensure that exclusive breastfeeding has in fact occurred since birth. The aim of this study was to investigate the growth of healthy infants in Sweden in whom exclusive breastfeeding for the first 4-6 mo was ascertained through daily feeding records and to compare the results with the World Health Organization (WHO) "12-month breastfed pooled data set" and the Euro-Growth references for exclusively breastfed infants, as well as with the National Center for Health Statistics (NCHS)/WHO reference. Methods: 147 exclusively breastfed infants and 325 non-exclusively breastfed Swedish infants, with a birthweight of 33 kg, were included. The mothers had previous breastfed at least one infant for at least 4 mo. Weight was recorded fortnightly and length monthly. Results: Infants exclusively breastfed since birth showed similar growth in weight and height to that of the non-exclusively breastfed infants. During the first 6 mo of life the growth of exclusively breastfed infants was also similar to that of the infants regularly receiving formula at 12-16 wk of age, mostly in addition to breast milk. The monthly growth increments were fairly similar to those of the "WHO pooled breastfed data set" and the Euro-Growth references for exclusively breastfed infants. Conclusion: In an affluent society truly exclusively breastfed infants seem to have the same growth during the first half year of life as non-exclusively breastfed infants with a high breastfeeding rate.     

Modified vaccinia virus ankara recombinants are as potent as vaccinia recombinants in diversified prime and boost vaccine regimens to elicit therapeutic antitumor responses

Cancer vaccine regimens use various strategies to enhance immune responses to specific tumor-associated antigens (TAAs), including the increasing use of recombinant poxviruses [vaccinia (rV) and fowlpox (rF)] for delivery of the TAA to the immune system. However, the use of replication competent vectors with the potential of adverse reactions have made attenuation a priority for next-generation vaccine strategies. Modified vaccinia Ankara (MVA) is a replication defective form of vaccinia virus. Here, we investigated the use of MVA encoding a tumor antigen gene, carcinoembryonic antigen (CEA), in addition to multiple costimulatory molecules (B7-1, intercellular adhesion molecule-1, and lymphocyte function-associated antigen-3 designated TRICOM). Vaccination of mice with MVA-CEA/TRICOM induced potent CD4+ and CD8+ T-cell responses specific for CEA. MVA-CEA/TRICOM could be administered twice in vaccinia na?ve mice and only a single time in vaccinia-immune mice before being inhibited by antivector-immune responses. The use of MVA-CEA/TRICOM in a diversified prime and boost vaccine regimen with rF-CEA/TRICOM, however, induced significantly greater levels of both CD4+ and CD8+ T-cell responses specific for CEA than that seen with rV-CEA/TRICOM prime and rF-CEA/TRICOM boost. In a self-antigen tumor model, the diversified MVA-CEA/TRICOM/rF-CEA/ TRICOM vaccination regimen resulted in a significant therapeutic antitumor response as measured by increased survival, when compared with the diversified prime and boost regimen, rV-CEA/TRICOM/rF-CEA/TRICOM. The studies reported here demonstrate that MVA, when used as a prime in a diversified vaccination, is clearly comparable with the regimen using the recombinant vaccinia in both the induction of cellular immune responses specific for the "self"-TAA transgene and in antitumor activity.     

复方葆春袋泡茶质量标准研究

目的：制订复方葆春袋泡茶质量标准。方法：双波长薄层扫描法测定了五味子乙素的量,对淫羊藿,五味子,女贞子进行了薄层色谱鉴别。结果;加样回收率平均为９７．１５％（ＲＳＤ＝１．２％,ｎ＝５）,标准曲线ｒ＝０．９９９１,重复性ＲＳＤ＝１．４％（ｎ＝６）精密度ＲＳＤ＝２．３％（ｎ＝６）,结论,方法稳定,可靠,可作为该制剂的质量控制方法之一。