Quantification of intracardiac shunts by gold-195m, a new radionuclide with a short half life

Gold-195m, a radionuclide with a short half life (30.5 s) was used to quantify left to right intracardiac shunts. The results of this method were compared with those obtained with technetium-99m, a method that was validated against oximetry. In five patients the pulmonary to systemic flow ratio (greater than 3:1) obtained by both radionuclides indicated that the level of shunting was too high to be measured accurately. In one patient fragmentation of the bolus meant that no satisfactory gamma fit could be obtained. In the remaining 16 patients there was no significant difference between two successive 195mAu studies. The agreement between 99mTc results and 195mAu results was excellent. Oxygen administration, straight leg raising exercise, and the use of oblique projections did not affect the values of the pulmonary to systemic flow ratio. The technique of quantification of intracardiac shunts by 195mAu gives reproducible and accurate results and the low radiation dose means that it is suitable for use in children with suspected left to right shunts.     

Evaluation of sporontocidal compounds using Plasmodium falciparum gametocytes produced in vitro

A test system that uses infective gametocytes from in vitro cultures was developed for evaluating the sporontocidal activity of antimalarial compounds. In evaluating the system, pyrimethamine and cycloguanil (dihydrofolate reductase inhibitors) and primaquine (8-aminoquinoline) were tested against pyrimethamine-sensitive and pyrimethamine-resistant strains of Plasmodium falciparum. The drugs were administered to Anopheles either in a blood meal containing infective gametocytes or in a noninfective meal 2-4 days later. The mosquitoes were dissected 9-10 days after they received the infective blood meal, and the sporontocidal effect of the drugs was evaluated by the number of oocysts found in the gut. Both cycloguanil and pyrimethamine had marked sporontocidal activity. The susceptibility pattern of the strains to the sporontocidal effect of pyrimethamine and cycloguanil was similar to the susceptibility of their asexual blood stages in vitro to the schizontocidal effect of the compounds. The sporontocidal effect was observed only when the compounds were administered at the same time as the infective blood meal, but not when they were given 2-4 days later. No sporontocidal activity was observed with primaquine. This system permits more reliable quantitative observations than have been possible with previous methods.     

Preoperative and postoperative pulmonary function tests in patients with atrial septal defect and their relation to pulmonary artery pressure and pulmonary:systemic flow ratio.

Pulmonary diffusing properties and lung volumes were investigated in 44 patients with atrial septal defect, and in 30 of them preoperative and postoperative data were obtained. The patients were divided into three groups according to mean pulmonary artery pressure: less than or equal to 15 mm Hg (group 1), 16-29 mm Hg (group 2), and greater than or equal to 30 mm Hg (group 3). Patients in groups 1 and 2 had a high carbon monoxide transfer test which became normal after surgical correction of their septal defect. In group 3, the carbon monoxide transfer test was normal both before and after operation. As mean pulmonary artery pressure increased there was a progressive reduction in both forced expiratory volume in one second and vital capacity. Patients in group 3 had a low forced expiratory volume in one second, a low vital capacity, and a reduced forced expiratory volume in one second:vital capacity ratio. These abnormalities were not corrected by surgical closure of the septal defect. Formulas were derived from the lung function data, to predict the mean pulmonary artery pressure and the pulmonary:systemic flow ratio. The values predicted when these two formulas were applied to data obtained for patients in this study correlated well with measured values.     

Goldilocks on the couch: Moderate levels of psychodynamic and process-experiential technique predict outcome in psychodynamic therapy

Objectives: Greater symptom change is often assumed to follow greater technique use, a “more is better” approach. We tested whether psychodynamic techniques, as well as common factors and techniques from other orientations, had a curvilinear relation to outcome (i.e., whether moderate or “just right” intervention levels predict better outcome than lower or higher levels). Methods: For 33 patients receiving supportive-expressive psychodynamic psychotherapy for depression, interventions were assessed at Week 4 using the multitheoretical list of therapeutic interventions and symptoms were rated with the Hamilton Rating Scale for Depression. Results: Moderate psychodynamic and experiential techniques predicted greater symptom change compared to lower or higher levels. Conclusion: This “Goldilocks effect” suggests a more complex relation of intervention use to outcome might exist.     

Accuracy of the digital anal examination in women with fecal incontinence

Introduction and hypothesis

This study aims to determine the accuracy of digital rectal examination (DRE) to detect anal sphincter defects when compared to endoanal ultrasound (US) in women with fecal incontinence (FI).

Methods

Seventy-four patients identified by retrospective chart review who presented with complaints of bothersome FI who underwent endoanal US are the subjects of this analysis. Sensitivity, specificity, and positive and negative likelihood ratios were calculated for the ability of the DRE to detect anal sphincter defects.

Results

Anal sphincter defect was suspected on DRE in 75%. At endoanal US, external sphincter defects were noted in all three segments in 41% (complete defect) while partial defects were noted in 30%. DRE demonstrated a sensitivity of 82%, specificity of 32%, +likelihood ratio 1.2 (95% confidence interval (CI), 0.95–1.16) and ?likelihood ratio of 0.6 (95% CI, 0.2–1.24) for detecting a complete EAS defect on endoanal US.

Conclusion

DRE has poor specificity for detecting anal sphincter defects seen on endoanal US.     

急诊输尿管镜治疗输尿管结石并首次肾绞痛的疗效观察

目的 评价急诊输尿管镜治疗输尿管结石并首次肾绞痛的疗效.方法 本院2010年7月至2011年7月期间收治的140例输尿管结石患者纳入本研究范畴,其中60例输尿管结石患者首次肾绞痛时就诊,急诊行输尿管镜钬激光碎石,纳入第一组;80例患者对症处理后立即入院或肾绞痛再次发作入院并常规检查后再行输尿管镜钬激光碎石,纳入第2组.对两组患者的碎石效果、辅助治疗及相关并发症等指标进行比较,行统计学分析,得出结论.结果 140例患者均经输尿管镜检查,第1组结石大小0.80±0.31 cm,结石一次性清除率96.67％,无患者因结石疼痛再次就诊;第2组结石大小0.75±0.35 cm,结石一次性清除率95.00％,因结石疼痛再次就诊次数2.03±1.85,两组患者无严重并发症发生.结论 急诊输尿管镜治疗输尿管结石并首次肾绞痛安全可行,能及时解除疼痛.     

小腿外侧皮瓣修复手部皮肤缺损的临床应用

目的 探讨小腿外侧皮瓣修复手部皮肤缺损的临床应用.方法 对15例手部皮肤缺损面积大小约2.5 cm×3.2 cm～3.8 cm×5.0 cm的患者,采用小腿外侧皮瓣游离移植修复.皮瓣穿支动脉与手部动脉、伴行静脉或皮下静脉与手背静脉吻合,小腿供区创面直接缝合.结果 15例皮瓣全部存活,1例皮瓣术后出现血管危象,行手术探查重新吻合血管后存活,4例皮瓣术后3个月行皮瓣整形术.术后随访时间为2个月至2年,平均11个月,手部皮瓣外观满意,功能恢复良好;小腿供区隐蔽,创面仅留线状瘢痕.结论 小腿外侧皮瓣修复手部皮肤缺损是一种较理想的方法.     

5-氟尿嘧啶纳米药膜的体外缓释及其对结肠癌细胞抑制作用研究

目的研究担载抗肿瘤药物5-氟尿嘧啶(5-FU)的左旋聚乳酸(PLLA)共混羊毛蛋白纳米纤维药膜的缓释功能及其对结肠癌细胞的体外抑制效果。方法将PLLA与羊毛蛋白共混交联,并加入抗肿瘤药物5-FU,利用高压静电纺丝技术将共混溶液制作成具有缓释效果的纳米纤维薄膜。通过扫描电镜(SEM)观察其形貌。以高效液相色谱法(HPLC)测定5-FU/PLLA羊毛蛋白药膜中5-FU的缓释效果。采用噻唑蓝(MTT)比色法,检测药膜对结肠癌细胞HCT116的体外杀伤效果。同时采用倒置相差显微镜、透射电子显微镜(TEM)观测实验组细胞的生长情况。结果由SEM可以看出5-FU能够均匀分布在纳米纤维药膜中,HPLC显示5-FU能够缓慢释放并基本符合零级动力学规律。采用不同处理因素后,通过显微镜观察,药膜浸泡时间越长的实验组细胞出现肿胀、凋亡、坏死的情况越明显。MTT检测纳米药膜实验组的细胞存活率为(47.5±2.8)%,而不含药物的纯膜组对细胞基本无影响,其存活率为(93.9±2.8)%,差异具有统计学意义(P<0.01)。结论 5-FU/PLLA羊毛蛋白纳米药膜有明显缓释效果,具有较好的肿瘤细胞抑制作用和潜在的医疗应用价值。     

混合型肝癌临床特点及近期预后分析

目的 探讨混合型肝癌(mixed hepatocellular carcinoma and cholangiocarcinoma,mHCCCC)的临床特点及近期预后.方法 回顾分析2009年4月至2010年2月在浙江大学医学院附属第一医院病理确诊为mHCC-CC的17例患者的临床资料,总结其临床特点并统计术后生存时间. 结果 患者平均发病年龄27～76岁;其中男性11例(64.7％);无临床症状10例(58.8％);乙肝表面抗原阳性12例(70.6％);甲胎蛋白阳性( ＞25 ng/ml) 12例(75.1％);糖类抗原199阳性(≥37 U/ml)4例(25.0％).17例患者中肿瘤均完整切除,即包括转移灶在内的肿瘤切除,切缘离肿瘤边缘1.5 cm以上,同时清扫肉眼可见或影像学提示的肿大淋巴结.术后6、12和18个月累积生存率分别为93.8％、86.5％、57.7％;术后100、200 d的无瘤生存率分别为65.3％、43.5％;中位无瘤生存期为161 d.结论 mHCC-CC术前诊断困难,确诊依靠病理诊断;手术切除是主要治疗手段,但总体预后较差.     

In vitro characterization of peptide-modified p(AAm-co-EG/AAc) IPN-coated titanium implants.

Interpenetrating polymer networks (IPNs) of poly(acrylamide-co-ethylene glycol/acrylic acid) [p(AAm-co-EG/AAc)] functionalized with an -Arg-Gly-Asp- containing peptide derived from rat bone sialoprotein [bsp-RGD(15)] were grafted to titanium implants in an effort to modulate osteoblast behavior in vitro. Surface characterization data were consistent with the presence of an IPN, and ligand density measurements established that the range of peptide density on the modified implants spanned three orders of magnitude (0.01-20 pmol/cm2). In vitro biological characterization of the modified implants employing the primary rat calvarial osteoblast (RCO) model resulted in the identification of a critical ligand density (0.01相似文献