实体动态模型对鸟瞰磁性取样法测量左心室三维容积准确性的研究

目的　三维鸟瞰磁性取样法在患者有限的胸前声窗取样中具有潜在的快速及灵活的优越性 ,本研究的设计用来评价三维磁性传感系统在动态实体模型下对左心室每搏容积定量测量的准确性。方法　将一个代表左心室的乳胶气球膜型悬浮在水槽中 ,并与能产生 1 0个不同每搏输出量的泵相连1 5-6 5ｍｌ/ｂｅａｔ) ,探头频率 5 0ＭＨｚ,并装有鸟瞰 (ＦＯＢ)磁性接收器 (ＧＥ系统五 ) ,探头连续移动扫描气球 3 -7秒。所有图象贮存在磁盘上 ,用三维Ｅｃｈｏｐａｃ软件 (ＧＥ)根据Ｓｉｍｐｓｏｎ’ｓ法测量气球的容积 ,并与分别在收缩末期和舒张末期用传统的二维法 (1 / 2面积乘长度 )所测得的容积比较。最后将三维和二维法所测得的每搏输出量与直接测量气球容积所得的参考每搏输出量比较。 结果　相比较二维法所测得的每搏输出量与参考值之间的相关性 (ｙ =0 .49ｘ 8.6 8,ｒ=0 .87,ＳＥＥ =3 .87ｍｌ,Ｐ=0 .0 0 1 1 ;ｄｉｆｆｅｒｅｎｃｅｂｅｔｗｅｅｎ 2Ｄａｎｄ 3Ｄ ,Ｐ <0 .0 0 3 ) ,三维法所测值与参考值之间具有更好的相关性 (ｙ =0 .91ｘ 0 .41 ,ｒ=0 .97,ＳＥＥ =2 .83ｍｌ,Ｐ =0 .0 0 0 1 )。 结论　三维鸟瞰磁性取样法实用准确 ,必将有利于对左心室功能的评价     

Advances in interventional cardiology

The field of interventional cardiology is growing widely. This growth is the result of improvements in existing technology, development of new technology, and expansion of criteria for the selection of patients. Percutaneous transluminal coronary angioplasty (PTCA) remains the mainstay and is used to treat an increasing number of patients with coronary artery disease that manifests as stable or unstable angina or acute myocardial infarction. Atherectomy is being used to "debulk" lesions and remove atheromatous plaque as well as to remove intimal flaps after PTCA. The insertion of an intracoronary stent is a strategy designed to treat intimal dissections and acute closure as well as to attempt to decrease the incidence of restenosis. Finally, intracoronary laser therapy--independently or in combination with PTCA--is being evaluated as a treatment approach for more diffuse disease, acute occlusion, and prevention of restenosis.     

二氢吡啶介导的脑定向转释磺胺甲口恶唑的合成

目的：合成二氢吡啶介导的脑定向转释磺胺甲恶唑药物。方法：以磺胺甲恶唑和烟酸为原料,经酰化,烃化和还原反应制备「二氢吡啶－磺胺甲恶唑」偶联物。结果：「二氢吡啶－磺胺甲恶唑」偶联物及其中间体均经波谱鉴定。结论：本文结果为深入开发脑定向转释抗菌药物提供了重要参数。     

Paclitaxel is safe and effective in the treatment of advanced AIDS-related Kaposi's sarcoma.

PURPOSE: Liposomal anthracyclines are the present standard treatment for advanced AIDS-related Kaposi's sarcoma (KS). No effective therapies have been defined for use after treatment failure of these agents. A phase II trial was thus conducted with paclitaxel in patients with advanced KS to assess safety and antitumor activity. MATERIALS AND METHODS: A regimen of paclitaxel at a dose of 100 mg/m(2) was given every 2 weeks to patients with advanced AIDS-related KS. Patients were treated until complete remission, disease progression, or unacceptable toxicity occurred. RESULTS: Fifty-six patients with advanced AIDS-related KS were accrued. Tumor-associated edema was present in 70% of patients and visceral involvement in 45%. Forty patients (71%) had received prior systemic therapy; 31 of these were resistant to an anthracycline. The median entry CD4(+) lymphocyte count was 20 cells/mm(3) (range, 0 to 358). A median of 10 cycles (range, 1 to 54+) of paclitaxel was administered. Fifty-nine percent of patients showed complete (n = 1) or partial response (n = 32) to paclitaxel. The median duration of response was 10.4 months (range, 2.8 to 26.7+ months) and the median survival was 15.4 months. The main side effects of therapy were grade 3 or 4 neutropenia in 61% of patients and mild-to-moderate alopecia in 87%. CONCLUSION: Paclitaxel at 100 mg/m(2) given every 2 weeks is active and well tolerated in the treatment of advanced and previously treated AIDS-related KS. The median duration of response is among the longest observed for any regimen or single agent reported for AIDS-related KS. Paclitaxel at this dosage and schedule is a treatment option for patients with advanced AIDS-related KS, including those who have experienced treatment failure of prior systemic therapy.     

Anomalous origin of the brachiocephalic vessels with right aortic arch and contralateral subclavian steal syndrome

Summary Anomalies of origin of the brachiocephalic vessels are uncommon. The authors report a new case of such an abnormality revealed by a subclavian steal syndrome. The angiographic study showed a right aortic arch with hypoplasia of the origin of the left subclavian a., which arose from the descending aorta, and a collateral cervical circulation derived from the left vertebral a. and the right subclavian a.

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Anomalies d'origine des vaisseaux cervicaux à destinée encéphalique avec dextro-position de l'arc aortique et syndrome subclavier controlatéral

Résumé Les auteurs rapportent le cas d'une jeune femme ayant une symptomatologie évoquant un syndrome subclavier. Les différents examens vasculaires (Doppler, angiographie) ont montrés une anomalie d'origine des vaisseaux cervicaux à destinée encéphalique avec un arc aortique à droite par rapport à la trachée, une hypoplasie du segment proximal de l'a. subclavière gauche qui nait de l'aorte thoracique descendante et prise en charge du segment artériel distal par une circulation collatérale cervicale développée à partir des branches musculaires issues de l'a. vertébrale.

     

Subsequent health-care utilization associated with early physical therapy for new episodes of low back pain in older adults

Background

The association between early physical therapy (PT) and subsequent health-care utilization following a new visit for low back pain is not clear, particularly in the setting of acute low back pain.

Efficacy and Safety Outcomes of Extended Criteria Donor Kidneys by Subtype: Subgroup Analysis of BENEFIT‐EXT at 7 Years After Transplant

The phase III Belatacept Evaluation of Nephroprotection and Efficacy as First‐Line Immunosuppression Trial–Extended Criteria Donors Trial (BENEFIT‐EXT) study compared more or less intensive belatacept‐based immunosuppression with cyclosporine (CsA)–based immunosuppression in recipients of extended criteria donor kidneys. In this post hoc analysis, patient outcomes were assessed according to donor kidney subtype. In total, 68.9% of patients received an expanded criteria donor kidney (United Network for Organ Sharing definition), 10.1% received a donation after cardiac death kidney, and 21.0% received a kidney with an anticipated cold ischemic time ≥24 h. Over 7 years, time to death or graft loss was similar between belatacept‐ and CsA‐based immunosuppression, regardless of donor kidney subtype. In all three donor kidney cohorts, estimated mean GFR increased over months 1–84 for belatacept‐based treatment but declined for CsA‐based treatment. The estimated differences in GFR significantly favored each belatacept‐based regimen versus the CsA‐based regimen in the three subgroups (p < 0.0001 for overall treatment effect). No differences in the safety profile of belatacept were observed by donor kidney subtype.     

Rachitic respiratory distress in small preterm infants

A syndrome of subacute respiratory distress, severe metabolic bone disease affecting the thoracic cage, and mild cholestasis occurred in 4 small preterm infants during the first three months of life and was associated with considerable morbidity. The early radiological features in the chest resembled thos of the Mikity-Wilson syndrome, with which the disorder may be confused. After spontaneous improvement in hepatic function 3 of the infants fully recovered. The fourth died of paralytic ileus. Various nutritional and absorptive abnormalities probably contribute to the pathogenesis of the bone disorder in this syndrome. The best prophylaxis might be to supplement the diet with 25-hydroxyvitamin D rather than native vitamin D.