Complications in 8509 laparoscopic Falope ring sterilizations performed under local anaesthesia

During the 3-year period 1 January 1980-31 December 1982, 8509 laparoscopic Falope ring sterilizations were performed under local anaesthesia in rural areas of the Cape Province by the Sterilization Service of Tygerberg Hospital. Despite the fact that 476 of the patients had undergone previous lower abdominal surgery, major complications (anaphylactic shock after injection of lignocaine and inadvertent perforation of the bladder by the trocar) occurred in only 2 cases. It was not possible to complete the sterilization under local anaesthesia in 98 cases, resulting in a technical failure rate of 1.15%. A prospective study of the minor complications encountered among the 193 patients sterilized during November 1982 showed that torn tubes occurred in 3.1% and uterine perforation in 2.1%. This can be partially explained by the fact that evidence of previous pelvic infection was seen during laparoscopy in 9.3% of cases. The pregnancy rate after sterilization was 0.28% for the group as a whole.     

Skin testing for coeliac disease.

Subfractions of gluten from two genetically different New Zealand wheats were injected intradermally in 16 patients with coeliac disease and 20 healthy controls. The coeliac patients as a group exhibited greater skin reactions when examined at seven hours than the controls. However, the skin test did not give sufficient discrimination to make it clinically useful as a screening test for coeliac disease.     

Understanding dyspnea as a complex individual experience

Dyspnea is the highly threatening experience of breathlessness experienced by patients with diverse pathologies, including respiratory, cardiovascular, and neuromuscular diseases, cancer and panic disorder. This debilitating symptom is especially prominent in the elderly and the obese, two growing populations in the Western world. It has further been found that women suffer more strongly from dyspnea than men. Despite optimization of disease-specific treatments, dyspnea is often inadequately treated. The immense burden faced by patients, families and the healthcare system makes improving management of chronic dyspnea a priority.     

Delayed cerebral ischaemia after subarachnoid haemorrhage: looking beyond vasospasm

Despite improvements in the clinical management of aneurysmal subarachnoid haemorrhage over the last decade, delayed cerebral ischaemia (DCI) remains the single most important cause of morbidity and mortality in those patients who survive the initial bleed. The pathological mechanisms underlying DCI are still unclear and the calcium channel blocker nimodipine remains the only therapeutic intervention proven to improve functional outcomes after SAH. The recent failure of the drug clazosentan to improve functional outcomes despite reducing vasoconstriction has moved the focus of research into DCI away from cerebral artery constriction towards a more multifactorial aetiology. Novel pathological mechanisms have been suggested, including damage to cerebral tissue in the first 72 h after aneurysm rupture ('early brain injury'), cortical spreading depression, and microthrombosis. A greater understanding of the significance of these pathophysiological mechanisms and potential genetic risk factors is required, if new approaches to the prophylaxis, diagnosis, and treatment of DCI are to be developed. Furthermore, objective and reliable biomarkers are needed for the diagnosis of DCI in poor grade SAH patients requiring sedation and to assess the efficacy of new therapeutic interventions. The purpose of this article is to appraise these recent advances in research into DCI, relate them to current clinical practice, and suggest potential novel avenues for future research.     

Excessive daytime sleepiness is associated with altered gene expression in military personnel and veterans with posttraumatic stress disorder: an RNA sequencing study

Study ObjectivesPosttraumatic stress disorder (PTSD) is a common condition for military personnel and veterans. PTSD has been shown to impact gene expression, however, to date no study has examined comorbid conditions which may also impact gene expression, for example, excessive daytime sleepiness (EDS). As such, this study sought to examine gene expression using RNA sequencing across three group comparisons of military personnel and veterans: (1) PTSD with EDS (PTSDwEDS) versus PTSD without EDS (PTSDw/outEDS), (2) Controls (no PTSD or EDS) versus PTSDwEDS, and (3) Controls versus PTSDw/outEDS.MethodsWe performed experimental RNA-seq using Illumina’s HiSeq 2500 Sequencing System. We also used Ingenuity Pathway Analysis (IPA), a bioinformatics application, to identify gene pathways and networks which may be disrupted.ResultsThere were only two genes that were significantly dysregulated between the Controls and PTSDw/outEDS, therefore IPA analysis was not conducted. However, comparisons revealed that there was significant gene dysregulation between Controls and the PTSDwEDS (251 genes), and the PTSDwEDS versus the PTSDw/outEDS (1,873 genes) groups. Four candidate networks were identified via the IPA software for analysis. Significantly dysregulated genes across the four candidate networks were associated with sleep and circadian function, metabolism, mitochondrial production and function, ubiquitination, and the glutamate system.ConclusionsThese results suggest that PTSD with concurrent EDS is associated with gene dysregulation. This dysregulation may present additional biological and health consequences for these military personnel and veterans. Further research, to track these gene changes over time and to determine the cause of the EDS reported, is vital.     

人体1型糖尿病中的关键免疫细胞

1型糖尿病患者胰岛β细胞被破坏与胰岛自身反应性T细胞之间的直接联系从未被证明,对诊断后的疾病进程也所知无几.最近美国科学家的研究第一次对此有了直接的证据.冷冻胰腺样本来自病程在1周到超过50年的45例死亡患者的遗体捐赠,14例非糖尿病患者对照样本,5例有自身抗体的非糖尿病患者样本,2例孕期糖尿病患者样本,以及6例2型糖尿病患者样本.系统检查样本的组织切片是否存在有足够胰岛素的β细胞、CD8阳性的胰岛病变和1型HLA过度表达.最后,对表达HLA-A2的样本的连续切片用四聚体染色法针对6种已知确定的与1型糖尿病有关的胰岛自身抗原进行CD8 T细胞反应性检查.在临床确诊后最长达8年的分组患者胰岛样本中单一和多种CD8 T细胞反应性都检测到了.1型糖尿病特有的1型HLA过度表达和胰岛炎等病理特征存在于一小部分病程很长的患者中.在受影响的器官中.胰岛病变持续存在,表现为不同程度的浸润和β细胞丢失.该研究为人体胰岛自身反应性提供了第一个直接证据并强调了发病历程的异质性和长期性.