偏头痛大鼠脑内5-羟色胺1F和诱导型一氧化氮合酶基因的表达变化及针刺的干预效应

目的:前期实验已证实针刺治疗偏头痛疗效优越。观察针刺对偏头痛大鼠脑内5-羟色胺1F和诱导型一氧化氮合酶mRNA表达的调控作用。方法:实验于2005-11/2006-05在中南大学湘雅医院中西医结合研究所实验室完成。①选用SD大鼠40只,按随机数字表法分为4组(n=10),除正常对照组外,其余3组均复制大鼠偏头痛模型。模型对照组只造模,不作其他处理;针刺治疗组造模后进行针刺;针刺预防组针刺后造模电刺激20min。针刺方法:针刺大鼠双侧太冲、阳陵泉穴20min。采用疏密波,电流强度0.3～0.6mA,留针20min,1次/d,共5次。②实验完毕后取脑干及三叉神经节匀浆,采用反转录-聚合酶链反应法测定5-羟色胺1F和诱导型一氧化氮合酶mRNA表达。结果:进入结果分析正常对照组10只,模型对照组、针刺治疗组、针刺预防组各9只,共脱失3只。①与正常对照组比较,模型对照组大鼠诱导型一氧化氮合酶mRNA表达显著增强(P<0.01),5-羟色胺1FmRNA表达显著减弱(P<0.01)。②与模型对照组比较,针刺预防组和针刺治疗组诱导型一氧化氮合酶mRNA表达明显减弱(P<0.01),5-羟色胺1FmRNA表达显著增强(P<0.01)。结论:针刺调控5-羟色胺1F和诱导型一氧化氮合酶mRNA的表达可能是针刺防治偏头痛的分子机制。     

建立自体骨碎末移植材料恢复骨缺损的实验模型

目的:建立恢复种植体周围骨缺损的自体骨碎末骨移植材料的实验模型。方法:实验于2005-08/2006-04在大连医科大学动物实验基地(辽宁省重点实验室)完成。①实验材料:健康杂交家犬5只,体质量15～20kg。Bio-Oss骨移植材料为引导骨/组织再生多孔骨无机材料,白色颗粒状,颗粒大小1.0～2.0mm。②实验方法:拔除家犬下颌第1,2,3前臼齿,3个月后行种植术。预备种植体窝,每只犬左右两侧各预备4个,共40个。在每个种植窝内,各植入种植体钛钉1枚,共40枚。用种植转孔时收集的自体骨碎末、Bio-Oss骨移植材料及两者1∶1混合骨碎末恢复种植体颊侧单壁人为骨缺损,以未植骨作空白对照。③实验评估:第9周时观察各组骨量的恢复情况、X线片观察牙槽骨高度、骨小梁致密度及骨整合情况,亚甲基蓝-碱性品红法观察组织学变化。结果:5只家犬钛钉均无脱落,均纳入结果分析。①一般情况:9周时,创口愈合均良好,钛钉稳定,总存留率为100%。骨缺损处已有不同程度恢复,与正常骨组织无明显差别。②9周时各组骨缺损量的测量结果:植入自体骨碎末、Bio-Oss骨移植材料、混合骨碎末及空白对照组的平均骨缺损量分别为1.8125、1.6975、1.5025、2.6375mm。植入混合骨碎末的平均骨缺损量最小,说明恢复最佳。③X线观察骨量的恢复情况:40颗钛钉外周均与骨组织紧密接触,愈合良好。不同组间未见明显骨质密度区别。④组织学观察骨量的恢复情况:低倍镜下见所有钛钉均被周围淡红色的致密骨组织紧密包绕,种植体与骨组织间无蓝色的软组织,产生了直接骨结合界面。结论:应用家犬建立自体骨碎末移植材料恢复种植体周围骨缺损的实验模型效果理想。     

Assessment of emergency physician–performed ultrasound in evaluating nonspecific abdominal pain

Study objective

The objective of this pilot study was to lay the groundwork for future studies assessing the impact of emergency physician–performed ultrasound (EPUS) on diagnostic testing and decision making in emergency department (ED) patients with nonspecific abdominal pain (NSAP).

Methods

This was a prospective, noninterventional study using a consecutive sample of patients presenting to the ED with NSAP as determined by nursing triage when a participating physician was available. Nonspecific abdominal pain was defined as abdominal pain for which the patient was seeking evaluation without a presumed diagnosis or referral for specific evaluation. Patients were evaluated by a physician who documented their differential diagnosis and planned diagnostic workup. Then, the physician performed EPUS, recorded their findings, and documented their post-EPUS differential diagnosis and planned diagnostic workup. This was compared with the patient's final diagnosis as determined by 2 emergency physicians blinded to the EPUS results.

Results

A total of 128 patients were enrolled. Fifty-eight (45%; 95% confidence interval [CI], 36%-54%) had an improvement in diagnostic accuracy and planned diagnostic workup using EPUS. Sixty-four (50%; 95% CI, 41%-59%) would have been treated without further radiographic imaging. Fifty (39%; 95% CI, 31%-48%) would have been treated without any further laboratory testing or imaging.

Discussion

Based on our findings, a future trial of 164 consecutive patients would have 90% power to confirm a 25% reduction in testing and a 25% improvement in decision making.

Conclusion

Emergency physician–performed ultrasound appears to positively impact decision making and diagnostic workup for patients presenting to the ED with NSAP and should be studied further.     

Abnormal function of the bone marrow microenvironment in chronic myelogenous leukemia: role of malignant stromal macrophages

The bone marrow microenvironment supports and regulates the proliferation and differentiation of hematopoietic cells. Dysregulated hematopoiesis in chronic myelogenous leukemia (CML) is caused, at least in part, by abnormalities in CML hematopoietic progenitors leading to altered interactions with the marrow microenvironment. The role of the microenvironment itself in CML has not been well characterized. We examined the capacity of CML stroma to support the growth of long-term culture-initiating cells (LTC-IC) obtained from normal and CML marrow. The growth of normal LTC-IC on CML stroma was significantly reduced compared with normal stroma. This did not appear to be related to abnormal production of soluble factors by CML stroma because normal LTC- IC grew equally well in Transwells above CML stroma as in Transwells above normal stroma. In addition, CML and normal stromal supernatants contained similar quantities of both growth-stimulatory (granulocyte colony-stimulating factor (CSF), interleukin-6, stem cell factor, granulocyte-macrophage CSF, and interleukin-1 beta) and growth- inhibitory cytokines (transforming growth factor-beta, macrophage inflammatory protein-1 alpha, and tumor necrosis factor-alpha). The relative proportion of different cell types in CML and normal stroma was similar. However, polymerase chain reaction and fluorescence in situ hybridization studies showed the presence of bcr-abl-positivo cells in CML stroma, which were CD14+ stromal macrophages. To assess the effect of these malignant macrophages on stromal function, CML and normal stromal cells were separated by fluorescence-activated cell sorting into stromal mesenchymal cell (CD14-) and macrophage (CD14+) populations. CML and normal CD14- cells supported the growth of normal LTC-IC equally well. However, the addition of CML macrophages to normal or CML CD14- mesenchymal cells resulted in impaired progenitor support. This finding indicates that the abnormal function of CML bone marrow stroma is related to the presence of malignant macrophages. In contrast to normal LTC-IC, the growth of CML LTC-IC on allogeneic CML stromal layers was not impaired and was significantly better than that of normal LTC-IC cocultured with the same CML stromal layers. These studies demonstrate that, in addition to abnormalities in CML progenitors themselves, abnormalities in the CML marrow microenvironment related to the presence of malignant stromal macrophages may contribute to the selective expansion of leukemic progenitors and suppression of normal hematopoiesis in CML.     

Evaluation of ultrasonic scaling unit waterline contamination after use of chlorine dioxide mouthrinse lavage

BACKGROUND: An infection control problem in dental operatories which is not fully controlled is waterline contamination by heterotrophic mesophilic bacteria. These bacteria are present in water supplies as a planktonic phase and adhere to the lumen of tubings as a biofilm comprised of their external cell surface glycocalyx and by production of extracellular carbohydrate polymers. The adherent film is most difficult to remove. The accumulated planktonic phase can be reduced significantly by flushing water from the lines before use in patient treatment, but will return when the equipment is idle through the accumulation of more planktonic phase and by slough of the biofilm surface-adsorbed phase not yet enmeshed in the carbohydrate matrix. Chlorine dioxide has antimicrobial activity against many bacteria, spores, and viruses. It is used in water supply treatment as a disinfectant and slime preventive and has an advantage over chlorine in that carcinogenic trihalomethanes are not generated. METHODS: This study compared use of phosphate buffer-stabilized chlorine dioxide (0.1%) mouthrinse as a lavage in ultrasonic dental scaler units with the use of tap water as a control. Sterile water flushed through the units onto heterotrophic plate count (HPC) sampler plates was cultured 7 days at room temperature and colonies were counted at 12x. One test and one control unit were used for biopsy of internal tubing and scanning electron microscopy imaging. RESULTS: The HPC counts, in colony forming units (CFU)/ml, were reduced 3- to 5-fold by flushing tap water through the units, but they returned after units were idle overnight. When phosphate-buffered chlorine dioxide mouthrinse was used as a lavage, CFU/ml were reduced 12- to 20-fold. Holding chlorine dioxide in waterlines overnight reduced recurrent buildup compared to water (P <0.05). Scanning electron microscopy images indicated a significant reduction of biofilm coverage by chlorine dioxide as compared to water (P<0.001). CONCLUSIONS: Phosphate-buffered chlorine dioxide mouthrinse was effective in these short-term trials for control of waterline contamination in ultrasonic dental scaling units. It should prove as useful in dental professional waterline applications as it has in industrial uses for biofilm control.     

Endocrine profiles of patients with testicular tumors treated with radiotherapy

Blood samples for hormone analysis were obtained 5 to 20 years post-therapy from 12 men with testicular tumors who were originally treated by unilateral orchiectomy followed by abdominal and/or pelvic irradiation. In nine patients (75%) the levels of FSH and LH, and in one patient (8%) the testosterone values, were outside the ranges found in age- and sex-matched controls. From this retrospective study we conclude that, even when the remaining testis is kept outside the field of radiation, significant radiation damage occurs, mainly through scatter. This damage is more likely to occur if the hemiscrotum is irradiated. Methods of shielding are available to reduce the dose received by the contralateral testis.     

Socioeconomic status and health: education and income are independent and joint predictors of ambulatory blood pressure

Journal of Behavioral Medicine - Epidemiological research suggests that different indicators of socioeconomic status (SES) such as income and education may have independent and/or interactive...     

Comparison of the NovaSom QSG, a new sleep apnea home-diagnostic system, and polysomnography

BACKGROUND: Obstructive sleep apnea (OSA) is a serious, common, and underdiagnosed disorder that challenges health care resources. While polysomnography (PSG) represents the standard diagnostic test for OSA, portable devices provide an alternative diagnostic tool when issues of cost, time, geographic availability, or other constraints pose impediments to in-lab testing. This study compares the NovaSom QSG, a new sleep apnea home diagnostic system, to PSG both in the laboratory and in the home. METHODS: Fifty-one consecutive adults referred to the sleep lab for suspicion of OSA underwent one night of in-lab, simultaneous recording of PSG and NovaSom QSG in addition to using the NovaSom QSG at home for three nights. Two separate comparisons were made using the apnea-hypopnea index (AHI): in-lab PSG to in-lab NovaSom QSG and in-lab PSG to home NovaSom QSG. RESULTS: Using a clinical cut-off of AHI=15, the sensitivity and specificity of the in-lab NovaSom QSG vs. PSG were 95% and 91%, respectively. For home NovaSom QSG vs. in-lab PSG, the sensitivity was 91% and specificity was 83%. The intra-class correlation coefficient for the agreement between three separate nights of NovaSom QSG home data was 0.88. CONCLUSIONS: In a patient population suspected of having OSA, the NovaSom QSG demonstrated acceptable sensitivity and specificity both in the lab and self-administered in the home, when compared to PSG.