Microsurgical removal of intramedullary spinal cord gliomas in a rat spinal cord decreases onset to paresis,an animal model for intramedullary tumor treatment

OBJECTIVE: Intramedullary spinal cord tumors (IMSCT) pose significant challenges given their recurrence rate and limited treatment options. Using our previously described rat model of IMSCT, we describe a technique for microsurgical tumor resection and present the functional and histopathological analysis of tumor progression. METHODS: Twenty-four Fischer 344 rats were randomized into two groups. All animals received a 5-mul intramedullary injection of 9L gliosarcoma cells. Animals were evaluated daily for signs of paralysis using the Basso, Beattie, and Bresnahan (BBB) scale. Group 1 continued with daily assessments using the BBB scale following tumor implantation, but received no further treatment. Group 2 underwent surgical removal of intramedullary tumor on postoperative day five. At a BBB score less than 5 (e.g., functional paraplegia), all animals of both groups were killed and sent for histopathological analysis. RESULTS: Group 1 had a median onset of functional hind limb paraplegia at 15 +/- 1.0 days. Group 2 had a median onset of hind limb paresis at 53 +/- 0.46 days. Hematoxylin-eosin cross-sections confirmed the presence of intramedullary 9L tumor invading the spinal cord in both groups. CONCLUSION: Animals with 9L IMSCTs consistently developed hind limb paraplegia in a reliable and reproducible manner. Animals undergoing microsurgical resection of IMSCT had a significant delay in the onset of functional paraplegia compared to the untreated controls. These findings suggest that this model may mimic the behavior of IMSCTs following operative resection in humans and thus may be used to examine efficacy of new treatment options for high-grade intramedullary tumors.     

Defective interleukin 2 production in patients after bone marrow transplantation and in vitro restoration of defective T lymphocyte proliferation by highly purified interleukin 2

Using OKT3 monoclonal antibody as a mitogen, we have studied interleukin 2 (IL2) production and proliferation in peripheral blood mononuclear cells (PBMC) of 23 patients receiving bone marrow transplants. Twenty patients were recipients of allogeneic bone marrow for treatment of hematologic malignancies, aplastic anemias (AA), or severe combined immunodeficiencies (SCID). Three patients with Hodgkin's disease or neuroblastoma received autologous bone marrow. Endogenous IL2 production was not detectable (less than 0.2 U/mL) in PBMC of 18 patients and was very low in PBMC from five patients (0.5 to 1.5 U/mL), as compared to normal controls (median 3.5 U/mL) or pretransplant patients (median 1.5 U/mL). The low IL2 production was associated with defective OKT3-induced proliferation of PBMC in 19 of 23 patients studied. In the first 6 months after BMT, 14 of 15 patients (93%) showed defective proliferation of PBMC as compared to five of eight patients (63%) tested between 7 and 18 months after BMT (P less than .1). In all but three patients, addition of highly purified human lymphocyte IL2 (hpIL2) restored OKT3-induced proliferation of PBMC to within the normal range. This study demonstrates that PBMC in patients after BMT have a defect of IL2 production but are able to express IL2 receptors in response to OKT3 antibody and to proliferate normally upon addition of hpIL2. PBMC of all patients showed similar functional defects, whether or not they received additional therapy, including various conditioning regimens prior to BMT and immunosuppressive therapy after BMT. These observations suggest that T cell defects after BMT are most likely secondary to quantitative or qualitative defects of transplanted T lymphocytes or their precursors.     

Laparoscopic versus ultrasound-guided visualization of transversus abdominis plane blocks

BackgroundUltrasound-guided (US) transversus abdominis plane (TAP) block is commonly utilized as part of a multi-modal approach for postoperative pain management. This study seeks to determine whether laparoscopic-guided TAP blocks are as effective as US-guided TAP blocks among pediatric patients.MethodIn this prospective, randomized controlled trial, pediatric patients undergoing laparoscopic procedures were randomly assigned to one of two treatment arms: US-guided TAP block (US-arm) or laparoscopic-guided TAP block (LAP-arm). Primary outcome was PACU pain scores. Secondary outcomes included PACU opioid consumption, block completion time and block accuracy.ResultsTwenty-five patients were enrolled in each arm. In the LAP-arm, 59% of blocks were in the transversus abdominis plane compared to 74% of TAP blocks in the US-arm (p = 0.18). Blocks were completed faster in the LAP-arm (2.1 ± 1.9 vs. 7.9 ± 3.4 min, p<0.001). The average highest PACU pain score was 3.4 ± 3.1 for the LAP-arm and 4.3 ± 3.8 for the US-arm (p = 0.37). Overall PACU pain scores and opioid consumption were similar between the groups (1.2 ± 1.3 vs. 1.6 ± 1.6, p = 0.24; 2.2 ± 5.8 vs. 0.9 ± 1.4MME, p = 0.26).ConclusionLaparoscopic TAP blocks have equivalent efficacy in post-operative pain scores, narcotic use, and tissue plane accuracy as compared to US-guided TAP blocks. They are also completed faster and may result in less operating room and general anesthetic time for the pediatric patient.     

Acute superior oblique palsy in monkeys: III. Relationship to Listing's Law

PURPOSE: To investigate the three-dimensional orientation of the eye and its relationship to Listing's Law in monkeys with acute acquired superior oblique palsy (SOP). METHODS: The trochlear nerve was severed intracranially in two rhesus monkeys. Three-axis eye movements (horizontal, vertical, and torsion) were measured with binocular, dual search coils during fixation of targets in a 40 degrees x 40 degrees grid. Rotation vectors were calculated, and Listing's plane (LP) was determined by a least-squares planar fit of eye torsion as a function of horizontal and vertical position. RESULTS: The main findings were: (1) In the paretic eye, there was an immediate and sustained rotation of the orientation plane by approximately 25 degrees in the temporal direction; (2) the thickness of LP, defined as the torsional standard deviation (SD), increased little (by 0.13 degrees in M1 and 0.08 degrees in M2) after SOP, and (3) the SD of intrasaccadic torsion was slightly greater than that during fixation, but there was no change after SOP. CONCLUSIONS: Acute SOP in rhesus monkeys leads to a temporal rotation of LP. This is consistent with a relatively increased extorsion in down gaze due to a loss of normal intorsion by the superior oblique muscle. The SD of torsion increased by only a small amount, implying that the validity of Listing's Law is not affected much by complete SOP, despite the large change in the orientation of LP.     

Optimal nutrition during the period of mechanical ventilation decreases mortality in critically ill, long-term acute female patients: a prospective observational cohort study

Introduction  

Optimal nutrition for intensive care patients has been proposed to be the provision of energy as determined by indirect calorimetry, and protein provision of at least 1.2 g/kg pre-admission weight per day. The evidence supporting these nutritional goals is based on surrogate outcomes and is not yet substantiated by patient oriented, clinically meaningful endpoints. In the present study we evaluated the effects of achieving optimal nutrition in ICU patients during their period of mechanical ventilation on mortality.     

Obstruction of the left hepatic duct: diagnosis and treatment by selective fine-needle cholangiography and percutaneous biliary drainage

Obstruction of the left hepatic duct due to periportal pathologic conditions was identified by fine-needle transhepatic cholangiography in 28 patients. Selective cholangiography of the left duct was performed in 30 instances and subsequent selective left-sided catheter decompression was carried out in 23 cases. Techniques for selective puncture and drainage of the left duct required procedure modifications to accommodate the specific anatomic and pathologic features of the obstructed left duct system. Ultrasonography was indispensable as an aid to delineation of the left duct anatomy for directing needle puncture. Accurate documentation and successful catheter drainage of left duct obstruction are important contributions to the total management of patients with high biliary obstruction.     

美国国家骨髓库无关供者造血干细胞移植20年回顾

自美国国家骨髓库(NMDP)开展第一例无关供者移植以来,至今已有20年.NMDP目前的库容量已逾700万,已为6大洲提供了30 000多份无关供者造血干细胞.这一辉煌成就是美国国家骨髓库600多名工作人员共同努力的结果,同时也得益于广泛的国际合作,包括171个移植中心,73个供者中心,24个脐血库,97个骨髓采集中心,91个血液净化中心,26个HLA分型实验室和26个合作供者登记处.本文回顾了美国国家骨髓库的历史,阐述了20年来移植病人、移植物来源和预处理方案几方面的主要变化趋势.