Results of percutaneous transluminal angioplasty

Percutaneous transluminal angioplasty (Dotter technique) was used in 2,942 cases of iliofemoral atheromatous disease. Results varied with the characteristics of the obstructing lesion (length and location) and the clinical stage of ischemia (claudication, rest pain, gangrene). Based on the foregoing, angioplasty is done either as the preferred primary treatment or for the relief of clinically advanced disease in patients unsuitable for high risk surgery. Success is favored by the use of aggregation inhibitors and single-use Teflon or balloon catheters; complications are few.     

Aortic atherosclerotic lesions in the thoracic aorta detected by multiplane transesophageal echocardiography as a predictor of coronary artery disease in elderly patients

BACKGROUND: The presence of atherosclerotic lesions in the thoracic aorta by transesophageal echocardiography (TEE) appears to be a marker for the presence of significant coronary artery disease (CAD) in the general population. HYPOTHESIS: We investigated whether atherosclerotic lesions in the thoracic aorta, by multiplane TEE, could be a marker for CAD in elderly patients. METHODS: In all, 127 patients (67 men, 60 women, aged 68 +/- 13 years), underwent a TEE study with imaging of the thoracic aorta and cardiac catheterization with coronary angiography. The presence of a distinct, linear, or focal, highly echogenic mass protruding into the vessel lumen was the criterion for the diagnosis of atherosclerotic plaque. RESULTS: Atherosclerotic lesions were found in 30 of 36 patients (83.3%) with and in 20 of 91 (22%) without CAD. Of the 41 patients > or = 70 years, atherosclerotic lesions were detected in 14 of 17 (82.3%) with and in 13 of 24 patients (54%) without CAD. The sensitivity, specificity, and positive and negative predictive values in this group were 82.3, 46, 52, and 78.6%, respectively. Multivariate logistic regression analysis revealed that in patients aged > or = 70 years only advanced atherosclerotic lesions were independent predictors of significant CAD. However, the high negative predictive value of the method indicates that the absence of aortic plaque is a strong predictor of the absence of CAD. CONCLUSIONS: The presence of atherosclerotic lesions in the thoracic aorta is a strong predictor of CAD only in patients < 70 years old. However, the negative predictive value of the method is high for all patients regardless of age.     

大鼠坐骨神经分支选择结扎切断模型的建立及脊髓背脚N-甲基-D-天冬氨酸受体检测

目的采用免疫组织化学方法,观察SNI模型大鼠脊髓背角神经元NMDAR的表达。方法健康雄性SD大鼠15只,随机分为3组：对照组（C1组）、假手术组（C2组）和生理盐水组（NS组）,每组5只。C1组不做任何处理,其他2组均根据改良Yaksh法进行鞘内置管。置管5d后,NS组按Woolf等方法建立神经病理性疼痛模型（SNI）,C2组除不损伤神经外处理同NS组;制模2d后,C2组和NS组用微量注射器鞘内注射20μL生理盐水,然后用生理盐水冲管（共20μL）。在30min后,C2组、NS组均进行疼痛行为学观察。3组均在注药后2h处死大鼠,用免疫组化法观察大鼠腰5节段水平脊髓背角NMDAR的表达。结果C1组和C2组在各时点均无机械性异常疼痛出现,热刺激后爪退缩潜伏时间差异也均无统计学意义（P〉0.05）;NS组在SNI手术后第1天和第2天出现明显的痛觉过敏（机械性异常疼痛痛阈降低）,与C1组比较差异有统计学意义（P〈0.01）,但对热刺激的后爪退缩潜伏时间与C1组比较差异无统计学意义（P〉0.05）;NS组大鼠脊髓背角NMDAR免疫阳性细胞数量与C1及C2组比较明显增加,两者之间差异有统计学意义（P〈0.05）;NS组的脊髓背角NMDAR免疫阳性细胞数密度值与C1,C2组相比显著增高（P〈0.05）,NS组的阳性细胞光密度值较C1组和C2组增高（P〈0.05）。结论SNI模型可引起大鼠损伤侧肢体机械性痛觉过敏,但对热刺激不敏感;SNI模型引起大鼠脊髓背角神经元NMDAR表达上调。     

Dynamic probabilistic model for determination of optimal timing of surveillance chest radiography in pediatric Hodgkin disease

A dynamic probabilistic model based on hazard rate analysis, Monte Carlo modeling, and lead-time estimation techniques was developed to determine the optimal timing and frequency of chest radiography in the monitoring for relapse of children with treated Hodgkin disease. The analysis incorporates the performance characteristics of chest radiography, the natural history of the disease process, and therapeutic efficacy as a function of earliness of detection in the determination of optimal strategy. Examples of the model applied to the experiences of Stanford Medical Center and St. Jude Children's Research Hospital illustrate the utility of such a model in customizing an optimal monitoring strategy for a specific institution and clinical experience. The results suggest that monitoring protocols significantly overutilize chest radiography in the evaluation for recurrent Hodgkin disease in children.     

L-精氨酸对5/6肾大部切除大鼠残余肾代偿性增生的影响

目的观察１％Ｌ－精氨酸（Ｌ－ａｒｇ）饮食对５／６肾大部切除大鼠（ＳＮｘ）残余肾代偿性增生（ＣＲＧ）的影响。方法实验分组：（１）假手术（ｓｈａｍ）组；（２）ｓｈａｍ＋Ｌ－ａｒｇ组；（３）ＳＮｘ组；（４）ＳＮｘ＋Ｌ－ａｒｇ组。大鼠于术后３０天处死，观察Ｌ－ａｒｇ对残余肾湿重（ＫＷ）、肾重／体重比（ＫＷ／ＢＷ）、ＣＲＧ、残余肾蛋白质、ＤＮＡ含量、细胞增生以及平均肾小球体积（ＶＧ）的影响。结果Ｌ－ａｒｇ明显增加ＫＷ（Ｐ＜０．０５）、ＫＷ／ＢＷ（Ｐ＜０．０５）、ＣＲＧ（Ｐ＜０．０５）以及残余肾蛋白质、ＤＮＡ含量（Ｐ分别＜０．０１，０．００１）。免疫组化显示，残余肾小管、间质增殖细胞核抗原（ＰＣＮＡ）阳性细胞数明显增加（Ｐ＜０．０５）。此外，ＳＮｘ＋Ｌ－ａｒｇ组ＶＧ较ＳＮｘ组增加１６％。结论Ｌ－精氨酸可能刺激残余肾代偿性增生，此为限制Ｌ－精氨酸饮食治疗慢性肾衰提供了理论依据     

中草药库房管理的现状分析及经验探讨

为了探讨和分析中草药库房管理的现状以及经验,在谷歌学术、中国知网、万方医学网等网站以中草药库房管理、现状及经验为关键词进行检索,然后结合本院中草药库房管理的实际经验,对近年来有关中草药库房管理的文献进行分析、总结,探讨和分析中草药库房管理的现状及经验。通过总结分析发现,在入库时对药品的质量进行验收,在储存时控制储存药材的条件,对库房进行微机化管理,能够有效保证中草药的质量和中草药的临床用药安全。加强对中草药库房的质量安全管理,可以保证患者的临床用药安全,更好的服务于临床。     

Long-term outcomes of liver transplant patients with human immunodeficiency virus infection and end-stage-liver-disease: single center experience

Objective

Orthotopic-liver-transplantation (OLT) in patients with Human-Immunodeficiency-Virus infection (HIV) and end-stage-liver-disease (ESDL) is rarely reported. The purpose of this study is to describe our institutional experience on OLT for HIV positive patients.

Material and methods

This is a retrospective study of all HIV-infected patients who underwent OLT at the University Hospital of Essen, from January 1996 to December 2009. Age, sex, HIV transmission-way, CDC-stage, etiology of ESDL, concomitant liver disease, last CD4cell count and HIV-viral load prior to OLT were collected and analysed. Standard calcineurin-inhibitors-based immunosuppression was applied. All patients received anti-fungal and anti-pneumocystis carinii pneumonia prophylaxis post-OLT.

Results

Eight transplanted HIV-infected patients with a median age of 46 years (range 35-61 years) were included. OLT indications were HCV (n = 5), HBV (n = 2), HCV/HBV/HDV-related cirrhosis (n = 1) and acute liver-failure (n = 1). At OLT, CD4 cell-counts ranged from 113-621 cells/μl, and HIV viral-loads from < 50-175,000 copies/ml. Seven of eight patients were exposed to HAART before OLT. Patients were followed-up between 1-145 months. Five died 1, 3, 10, 31 and 34 months after OLT due to sepsis and graftfailure respectively. Graft-failure causes were recurrent hepatic-artery thrombosis, HCV-associated hepatitis, and chemotherapy-induced liver damage due to Hodgkin-disease. One survivor is relisted for OLT due to recurrent chronic HCV-disease but non-progredient HIV-infection 145 months post-OLT. Two other survivors show stable liver function and non-progredient HIV-disease under HAART 21 and 58 months post-OLT.

Conclusions

OLT in HIV-infected patients and ESLD is an acceptable therapeutic option in selected patients. Long-term survival can be achieved without HIV disease-progression under antiretroviral therapy and management of the viral hepatitis co-infection.