Association study of apolipoprotein E epsilon4 with clinical phenotype and clozapine response in schizophrenia

Schizophrenic patients with the apolipoprotein E (APOE = gene; apoE = protein) epsilon4 allele exhibited lower psychosis scores than patients without the epsilon4 allele in previous reports. The present study tested the hypothesis that the APOE epsilon4 allele confers association with the clinical manifestations of schizophrenia or clozapine response. A total of 95 schizophrenic patients who were treatment resistant were included in the study. The results demonstrated that the presence of the APOE epsilon4 allele did not influence the response to clozapine in schizophrenic patients, neither was the baseline psychopathology related to the APOE epsilon4 allele. Given the multiple functions of the apoE protein in the brain, further study of the influence of APOE on CNS medication response is needed.     

Efficacy of multipurpose solutions for rigid gas permeable lenses

The use of multipurpose solutions for cleaning and disinfecting rigid gas permeable lenses has replaced single purpose solutions, but there are no reports of the efficacy of these multipurpose solutions, or of the effects of storage conditions on their disinfecting capacities. This study investigated activity against four bacterial and two fungal species, and the effects of storage in a refrigerator, at room temperature, at elevated temperature in both dry and humid conditions and with exposure to sunlight. The disinfecting solutions were challenged with the micro-organisms initially upon opening and then at 2-weekly intervals up to 12 weeks after being stored under the different conditions. Solutions were opened daily to simulate use. One solution failed to meet Food and Drug Administration (FDA) criteria to reduce numbers of bacteria by three log dilutions and of fungi by one log dilution. Storage reduced activity of all solutions over the 12-week period, but not below the requirements of the FDA. Storage in the refrigerator tended to reduce disinfecting capacity more quickly. Multipurpose solutions for rigid gas permeable (RGP) lenses lose activity over the 3 months recommended time of use but remain satisfactory for use over this time in the conditions tested. Practitioners need to remind patients to replace their solutions regularly and should advise against storage in the refrigerator. Multipurpose solutions for RGP lenses have simplified cleaning and disinfecting processes and the current formulations have improved disinfecting capacity compared to former disinfecting solutions, which is particularly important for wearers of orthokeratology lenses.     

Laparoscopic Ladd's procedure for intestinal malrotation: report of three cases.

Ladd's procedure for laparoscopic repair of malrotation has many advantages over conventional surgical techniques, such as earlier feeding and discharge. However, this procedure is still not commonly used in Taiwan. This report describes the results of treatment of intestinal malrotation in three patients using laparoscopic Ladd's procedure. The patients, aged 8 days, 17 days, and 3 years, underwent laparoscopic Ladd's procedure between July 1999 and September 2000. All three patients had symptoms of intermittent vomiting and were shown to have intestinal malrotation by upper gastrointestinal series study. The procedure was performed using three trocars of 5 mm diameter placed at the infraumbilical ring and the right and left lower quadrants. All procedures were completed laparoscopically. The operative times were 4.8, 3.6, and 3.5 hours, respectively. Feeding was started on postoperative Day 2 to 5, and the hospital stay was 6 to 11 days. Our results suggest that laparoscopic Ladd's procedure can be performed safely in pediatric patients. In addition, patients are expected to benefit from the smaller incision, earlier feeding, shorter hospital stay, and fewer complications compared with traditional Ladd's procedure.     

Concurrent chemotherapy-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: progression-free survival analysis of a phase III randomized trial.

PURPOSE: Nasopharyngeal carcinoma (NPC) is highly sensitive to both radiotherapy (RT) and chemotherapy. This randomized phase III trial compared concurrent cisplatin-RT (CRT) with RT alone in patients with locoregionally advanced NPC. PATIENTS AND METHODS: Patients with Ho's N2 or N3 stage or N1 stage with nodal size > or = 4 cm were randomized to receive cisplatin 40 mg/m(2) weekly up to 8 weeks concurrently with radical RT (CRT) or RT alone. The primary end point was progression-free survival (PFS). RESULTS: Three hundred fifty eligible patients were randomized. Baseline patient characteristics were comparable in both arms. There were significantly more toxicities, including mucositis, myelosuppression, and weight loss in the CRT arm. There were no treatment-related deaths in the CRT arm, and one patient died during treatment in the RT-alone arm. At a median follow-up of 2.71 years, the 2-year PFS was 76% in the CRT arm and 69% in the RT-alone arm (P =.10) with a hazards ratio of 1.367 (95% confidence interval [CI], 0.93 to 2.00). The treatment effect had a significant covariate interaction with tumor stage, and a subgroup analysis demonstrated a highly significant difference in favor of the CRT arm in Ho's stage T3 (P =.0075) with a hazards ratio of 2.328 (95% CI, 1.26 to 4.28). For T3 stage, the time to first distant failure was statistically significantly different in favor of the CRT arm (P =.016). CONCLUSION: Concurrent CRT is well tolerated in patients with advanced NPC in endemic areas. Although PFS was not significantly different between the concurrent CRT arm and the RT-alone arm in the overall comparison, PFS was significantly prolonged in patients with advanced tumor and node stages.     

生脉注射液在气管插管后血压降低中的运用

生脉注射液具有益气养阴、复脉固脱之功效,广泛用于严重感染、血容量不足引起的血压降低.在气管插管后血压降低时,应用生脉注射液也取得了较好的临床疗效.本文对气管插管后血压降低应用生脉注射液的用法用量、注意事项等进行了归纳.     

Native and oxidized low-density lipoproteins enhance superoxide production from diabetic rat glomeruli

Oxygen free radicals have been implicated in mediating diabetic complications, and patients with diabetic nephropathy frequently show increased levels of circulating and oxidized low-density lipoproteins (LDL). In the present study, we measured the superoxide production of glomeruli isolated from poorly controlled diabetic (streptozotocin) rats sacrificed 1 week and 1, and 3 months after the induction of diabetes. The animals were stimulated with native and oxidized LDL isolated from normal humans with normolipidemia. The superoxide ion was measured by using a spectrophotometer. The results demonstrated that the poorly controlled diabetic rat glomeruli showed a significantly higher production of superoxide than normal glomeruli under basal conditions, and this production increased further with the progression of diabetes. Stimulation with either LDL or oxidized LDL enhanced superoxide production by diabetic glomeruli, with oxidized LDL being more potent than LDL. Our results suggest that oxidized LDL may play important roles in the pathogenesis of diabetic nephropathy through enhanced generation of oxygen free radicals.     

Elective neck dissection or ＂watchful waiting＂： optimal management strategy for early stage NO tongue carcinoma using decision analysis techniques

Background Although tongue cancer is a common disease of the head and neck, the choice of neck treatment between elective neck dissection and ＂watchful waiting＂ remains controversial for patients with early stage NO oral tongue carcinoma. Methods On the basis of the current state of head and neck cancers a decision analysis model was created to compare two treatment strategies for early tongue cancer. Expected value （EV） was calculated according to the literature which met the defined criteria. Sensitivity analyses were performed. Results The results showed that the decision model favored elective neck dissection （EV=0.87）, over ＂watchful waiting＂ （EV=0.77）. One-way sensitivity analyses demonstrated that the outcome was influenced by regional recurrence, threshold value of 0.28 for the elective neck dissection group and 0.17 for the ＂watchful waiting＂ group, and a salvage rate threshold value 0.73 for the ＂watchful waiting＂ group. Conclusions These results suggested that elective neck dissection strategy of the neck should be applied for early stage NO oral tongue carcinoma patients with no clinical nodal metastases. When the occult lymph node metastases rate was less than 0.17 and the salvage rate was more than 0.73, ＂watchful waiting＂ strategy would be preferable.     

A Spherical Rotation Coordinate System for the Description of Three-Dimensional Joint Rotations

Three-dimensional joint rotations in human movement analysis have been mainly described by Euler/Cardan angles. Due to sequence dependence, each combination of three Euler/Cardan angles defines a single pattern of joint rotation. When the rotation pattern is unknown, it needs to be considered using a particular sequence of Euler/Cardan angles to represent joint rotations. In this paper a spherical rotation coordinate system is developed for describing three-dimensional joint rotations using a method of rotation involving two steps: a long axis rotation and a pure axial rotation. Two angles of the classical spherical coordinate system--longitude and latitude--are used to describe long axis rotations in this newly proposed coordinate system. The spherical rotation coordinate system uses a radial rotation angle to describe pure axial rotation of a limb segment whereas the classical spherical coordinate system uses a radial displacement to describe motion of a point. An application of the spherical rotation coordinate system is given to define three-dimensional rotations of the glenohumeral joint. A mathematical proof shows that the long axis rotation and axial rotation are sequence independent. Two numerical examples are investigated which demonstrate that the spherical rotation angles can be uniquely determined in both forward and inverse kinematics without considering sequences rotations.     

The relation between impairments and functional outcomes poststroke

OBJECTIVE: To assess the influence of initial stroke impairments on the severity of basic and higher level functional deficits over time and to determine the cumulative impact on functional deficits beyond severity of motor deficits alone. DESIGN: Observational study. SETTING: Twelve participating hospitals in the Greater Kansas City area, as part of the Kansas City Stroke Study (October 1995-March 1998). PARTICIPANTS: Individuals (n = 459) who sustained an eligible stroke were evaluated prospectively using standardized assessments at enrollment (within 14 days of stroke onset, 8.8 +/- 3.5 days). MAIN OUTCOME MEASURES: Mobility and activities of daily living (ADLs) were assessed at 1, 3, and 6 months poststroke using the Functional Independence Measure, Barthel index, Lawton Instrumental Activities of Daily Living (IADL), and the Medical Outcomes Study Short-Form Health Survey instruments. RESULTS: The cumulative probability of achieving independence with walking, a Barthel index of 60 or greater or 90 or greater, and independence in 3 or more IADL was significantly different for the following 4 impairment groups in descending order: motor; motor and somatosensory; motor and hemianopia; and motor, sensory, and hemianopia. Although motor severity was a strong predictor of outcome (p < .0001), the additional somatosensory and hemianopia deficits significantly (p < .05) affected time and likelihood of achieving these levels of function. CONCLUSION: Cumulative deficits poststroke affect patients' functional outcome in the first 6 months poststroke beyond the effect of motor severity alone.