Motor and cognitive development of infants with intraventricular hemorrhage, ventriculomegaly, or periventricular parenchymal lesions

Two hundred twenty-six moderate- or high-risk newborn infants were studied to examine the relationship between ultrasound findings in the newborn period and at 6 months and motor and cognitive deficits at 1 year. A three-part classification of abnormal ultrasound findings was used to grade intraventricular hemorrhage, ventriculomegaly, and parenchymal lesions. Abnormal ultrasound findings were observed in 48 infants, of whom 21 had intraventricular hemorrhage, 18 persistent ventriculomegaly, and nine parenchymal lesions. The incidence of deficits was as follows: normal ultrasound examination, 20%; intraventricular hemorrhage, 33%; persistent ventriculomegaly, 67%; and parenchymal lesions, 89%. The present study indicates that serial ultrasound examinations are indicated in preterm newborn infants less than 1500 gm and in selected newborn infants at risk and greater than 1500 gm at birth. The three-part classification of abnormal ultrasound findings should be used because of the predictive significance of persistent ventriculomegaly and parenchymal lesions for motor and cognitive deficits at 1 year of age.     

血小板激活因子对大鼠脑血管通透性的影响及药物的保护作用

颈内动脉注射血小板激活因子(PAF),再给伊文思蓝,可见脑实质染色程度加深,而颈内动脉只注射伊文思蓝,脑实质未见染色。而我们合成的新药SZ-1可剂量依赖性地抑制PAF诱导的脑实质伊文思蓝染色程度的加深。在体外培养的脑微血管平滑肌细胞上,PAF能显著刺激~(14)-花生四烯酸的释放,而SZ-1能剂量依赖性地抑制这种释放,提示PAF在脑内产生的损害除与其他因素相关外,还与其刺激花生四烯酸释放有密切关系,SZ-1对PAF引起的脑部损害有保护作用。     

Intravenous immunoglobulin therapy for streptococcal toxic shock syndrome--a comparative observational study. The Canadian Streptococcal Study Group.

Twenty-one consecutive patients with streptococcal toxic shock syndrome (TSS) between December 1994 and April 1995 were treated with a median dose of 2 g of intravenous immunoglobulin (IVIG)/kg (cases) and were compared with 32 patients with streptococcal TSS between 1992 and 1995 who did not receive IVIG therapy (controls). The outcome measure was 30-day survival. Patient plasma was tested for its ability to inhibit T cell activation induced by the infecting strain. The proportion of cases with 30-day survival was higher than that of the controls with 30-day survival (67% vs. 34%, respectively; P = .02). Multivariate analysis revealed that IVIG administration and a lower Acute Physiology and Chronic Health Evaluation II score were associated with survival; the odds ratio for survival associated with IVIG therapy was 8.1 (95% confidence interval, 1.6-45; P = .009). IVIG therapy enhanced the ability of patient plasma to neutralize bacterial mitogenicity and reduced T cell production of interleukin-6 and tumor necrosis factor alpha. IVIG may be an effective adjunctive therapy for streptococcal TSS, possibly because of its ability to neutralize bacterial exotoxins.     

Adolescent pregnancy--current trends and issues: 1998 American Academy of Pediatrics Committee on Adolescence, 1998-1999

Although the prevention of unintended adolescent pregnancy is a primary goal of the American Academy of Pediatrics and society, many adolescents continue to become pregnant. Since the last statement on adolescent pregnancy was issued by the Academy in 1989, new observations have been recorded in the literature. The purpose of this new statement is to review current trends and issues on adolescent pregnancy to update practitioners on this topic.     

Planning for children whose parents are dying of HIV/AIDS. American Academy of Pediatrics. Committee on Pediatric AIDS, 1998-1999

Although the character of acquired immunodeficiency syndrome is changing into a chronic illness, it is estimated that by the end of this century, 80 000 children and adolescents in the United States will be orphaned by parental death caused by human immunodeficiency virus infection. Plans for these children need to be made to ensure not only a stable, consistent environment that provides love and nurturing, but also the medical and social interventions necessary to cope with the tragic loss. Pediatricians should become aware of local laws and community resources and initiate discussion early in the course of parental illness to facilitate planning for the future care and custody of the children. States need to adopt laws and regulations that provide flexible approaches to guardianship and placement of children orphaned by acquired immunodeficiency syndrome.     

A study to the fibroblast—populated collagen lattices

ＦＤｅｐａｒｔｍｅｎｔｏｆＯｒａｌＭａｘｉｌｌｏｆａｃｉａｌＳｕｒｇｅｒｙ ,2ｎｄＣｌｉｎｉｃａｌＣｏｌｌｅｇｅｏｆＣｈｉｎａＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ ,Ｓｈｅｎｙａｎｇ 1 1 0 0 0 3,Ｃｈｉｎａ(ＷｕＺＱ)ＤｅｐａｒｔｍｅｎｔｏｆＯｒａｌＳｕｒｇｅｒｙ ,ＭｅｄｉｃｉｎｅａｎｄＰａｔｈｏｌｏｇｙ ,ＤｅｎｔａｌＳｃｈｏｏｌ,ＵｎｉｖｅｒｓｉｔｙｏｆＷａｌｅｓＣｏｌｌｅｇｅｏｆＭｅｄｉｃｉｎｅ ,ＣａｒｄｉｆｆＣＦ44ＸＹ ,ＵｎｉｔｅｄＫｉｎｇｄｏｍ (ＫＪＤａｖｉｅｓ ,ＤＷＴｈｏｍａｓ)ｉｂｒｏｂｌａｓ…     

肠源性内毒素血症与肝病

近年来,肠源性内毒素血症(intestinal endotoxemia,IETM)与肝病的关系日益受到重视.临床观察表明,各种急、慢性肝炎、肝硬变和重型肝炎患者内毒素血症(endotoxemia,ETM)发生率有不同程度升高.内毒素与肝损害之间存在着密切的关系[1-3].二者可互为因果,从而对肝病的发生发展产生重要影响.特别是内毒素作用于肝脏后,引起多种细胞因子分泌与释放,导致肝脏损害进一步加重,甚至出现黄疸、出血、肾功能衰竭与肝性脑病等肝功能衰竭临床综合征.     

The Impact of Neoadjuvant Chemoradiotherapy on Perioperative Outcomes, Tumor Pathology, and Survival in Clinical Stage II and III Esophageal Cancer

Background

The purpose of this study was to evaluate the impact of neoadjuvant chemoradiotherapy (NCR) on perioperative outcomes, tumor pathology, and survival following surgical resection of clinical stage II and III esophageal cancer.

Methods

Patients undergoing esophagectomy for clinical stage II and III cancer were divided into two groups: those who received NCR and those who underwent primary surgery (1991–2011).

Results

A total of 173 (50.9 %) of 340 stage II/III patients received NCR, 108 (31.8 %) patients underwent primary surgery, and 59 (17.4 %) underwent neoadjuvant chemotherapy followed by surgery. Patients who received NCR were younger but had a similar Charlson comorbidity index and incidence of adenocarcinoma. There were no differences between groups in the incidence of complications, in-hospital mortality, and ICU stay, but patients who received NCR demonstrated a reduced length of hospital stay. NCR was associated with a reduced the incidence of positive pathological lymph node status and positive resection margin (3.1 vs. 21.1 %) in stage III esophageal cancer. No overall survival benefit was seen with use of NCR, although a nonsignificant improvement in survival of 22 months (p = 0.06) was noted in patients with adenocarcinoma. Negative resection margin was associated with an improved survival in both stage II and III patients.

Conclusions

This study highlights the importance of planning operations to optimize the opportunity to provide negative surgical resection margins and to identify patients not responding to NCR to allow them to proceed directly to surgery. Additional assessment of the effect of NCR on patients with adenocarcinoma is warranted.     

Effect of cilostazol on experimental diabetic neuropathy in the rat

Summary Two proposed mechanisms of diabetic neuropathy are microvascular ischaemia and a reduction in Na,K-ATPase activity. We evaluated the effect of cilostazol, a drug that is both a potent phosphodiesterase inhibitor that normalizes nerve Na,K-AT-Pase and a vasodilator, on nerve blood flow (NBF) to determine whether it would improve experimental diabetic neuropathy. We examined whether epineurally applied cilostazol acted as a vasodilator on the peripheral nerve of normal and diabetic rats, and whether feeding the rats a cilostazol-supplemented diet could improve diabetic neuropathy. Cilostazol increased nerve blood flow (NBF) in a dose-dependent fashion with an EC₅₀ of 10^–5.74 mol/l. Cilostazol also normalized NBF in experimental diabetic neuropathy with a 10^–4 mol/l local application on the sciatic nerve. In diabetic neuropathy, a cilostazol-supplemented diet improved both NBF and nerve conduction in a dose- and time-dependent fashion. Potential mechanisms of action of cilostazol on the nerve include its effect on NBF, Na, K-ATPase, and restoration of the thromboxane:prostacyclin ratio. Cilostazol may have potential in the treatment of diabetic neuropathy.Abbreviations EDN Experimental diabetic neuropathy - NBF nerve blood flow - STZ streptozotocin - NRC control rats receiving normal diet - NRH control rats receiving a high (0.1%) cilostazol diet - CSH STZ rats receiving high (0.1%) cilostazol diet - CSL STZ rats receiving low (0.03%) cilostazol diet - CV conduction velocity