防治成人呼吸窘迫综合征的人工重组肺泡表面活性剂研制III.模型动物预防试验

人工重组肺泡表面活性剂（ＡＰＳ）是基于成人呼吸窘迫综合征（ＡＲＤＳ）发病中存在的肺泡表面活性剂缺乏和过量自由基引起肺损伤两种主要发病因素设计研制的。内毒素致ＡＲＤＳ大鼠的预防给药试验结果表明，ＡＰＳ能显著降低动物死亡率（４６４７％→１６１７％）和肺水肿程度（Ｗ／Ｄ从５５５→４８４）。同时，肺灌洗液的表面性能也有明显改善（平衡表面张力从６１８６→４７０２ｍＮ·ｍ－１，正常４３９４ｍＮ·ｍ－１；最小表面张力从３０４１→７１６ｍＮ·ｍ－１，正常３４９ｍＮ·ｍ－１）。动物初步预防试验的结果支持ＡＲＤＳ防治药物设计依据。     

Duodenitis: endoscopic-radiologic correlation in 272 patients

Potential radiologic findings of duodenitis were investigated in 272 patients, 157 with endoscopically diagnosed duodenitis and 115 endoscopically normal controls. The study assessed the value of four signs: folds more than 4 mm thick, mucosal nodules, bulbar deformity, and erosions. The most sensitive signs were thickened folds (72.0%) and nodularity (48.4%), while demonstration of erosions was the least sensitive (10.8%). Overall sensitivity (77.7%) approximated that for the radiologic diagnosis of peptic ulcer or esophagitis. Radiologic specificity (76.5%) was in the same range.     

Lymphoepithelial cyst of the pancreas： a case report

BACKGROUND: Lymphoepithelial cyst of the pancreas is a rare lesion of undetermined pathogenesis that had been documented almost exclusively in males. The literature on this entity is limited to reports of single or a small number of cases, METHODS: The case we described herein was compared with a total of 36 cases reported elsewhere. RESULTS: The 37 cases of lymphoepithelial cyst of the pancreas including our case were reviewed, Lymphoepithelial cysts have uniform and distinctive clinicopathologic features.     

螺内酯在慢性充血性心力衰竭治疗中的应用

1临床资料2003-01/2004-12,我院慢性充血性心力衰竭(心衰)住院患者238例中,使用螺内酯者185(男127,女58)例,使用率为77.7%(185/238),年龄32~96(平均61.2)岁.     

转移性黑色素瘤的姑息性放疔

目的：根据恶性黑色素瘤的放射生物学特性，设计了短疗程的放射治疗，以评价其在转移性患者中的姑息疗效。方法：21例(27个部位)转移性恶性黑色素瘤接受姑息性放疗，照射部位包括骨转移15个，淋巴结和皮下转移7个，脑转移5个。结合黑色素瘤生物特点和患者一般情况而制定时间-剂量模式，主要包括30Gy／10次／2周(10例，占37％)和20Gy／5次／1．5周(8例，占30％)。结果：总的姑息有效率为89％(24／27)，其中，骨和软组织转移的有效率为90％(20／22)，脑转移有效率为80％(4／5)。有效患者的中位缓解持续时间为60d，占剩余生存时问的67％。结论：短程放射治疗作为姑息治疗的手段，可以在大多数晚期转移性黑色素瘤患者中达到有效的减症作用。在高于常规分割剂量的基础上，可以视正常组织耐受性而适当降低分次剂量。总剂量的生物效应需达到相当于常规分割36Gy以获得较满意的姑息疗效。     

The dignity in advanced dementia (diadem) study: Developing an integrated geriatric palliative homecare program

Background: The prevalence of dementia is rising globally. Many patients suffer from the burdensome complications of advanced dementia as they are still poorly addressed. Aims: To describe the development of an interdisciplinary palliative homecare program for patients with advanced dementia and to develop a workflow that delineates the seamless continuation of care between the hospital and community with the homecare program. Design: Palliative care needs of patients and caregivers were established through a qualitative review of the literature. Appraisal tools were chosen based on their validity and feasibility in the homecare setting. Gaps in the healthcare system were identified and addressed as part of the integration of care between the hospital and the community. Setting/participants: Patients at Functional Assessment Staging (FAST) 7 with pneumonia, albumin level <35?g/L and/or enteral feeding were enrolled from a tertiary care hospital into the homecare program. Results: Patients’ symptom burden and quality of life were assessed. Caregivers were engaged in the planning of patients’ care. With the homecare program, patients and caregivers received support at home. Two physicians, seven nurses, and three social work professionals were educated about advanced dementia palliative care and medical information was communicated between different healthcare sites. Preliminary analysis of 306 patients revealed the presence of pain and neuropsychiatric behaviors. Impact of caregiving was mild to moderately severe. Conclusion: Advanced dementia is under-recognized as a terminal illness requiring specialized palliative intervention. Integrating a homecare palliative program into advanced dementia care is the first step towards palliating suffering at the end-of-life.     

PET/CT in initial staging and therapy response assessment of early mediastinal lymphoma

Objective

To detect accuracy of PET/CT in the initial staging, response after the first line and end of treatment in early mediastinal lymphoma patients compared to contrast CT.

Materials and methods

We studied 50 patients with pathologically proven lymphoma with a mean age = 27.5. All patients were at early stage. All patients performed CT and PET/CT for initial staging, after the first course of chemotherapy (after 4–6 weeks) and at the end of treatment (after 2–4 months).

Results

PET/CT upstaged 5 cases. At first line of treatment, PET/CT and CECT were agreeable in 32% of cases. PET/CT showed 100% sensitivity, 96.7% specificity, 95% positive predictive value and 100% negative predictive value. At the end of treatment both methods showed a 46% agreement. PET/CT was statistically significant in the follow up of hilar and axillary lymph nodes. PET/CT showed 100% sensitivity and specificity; compared to 62.5% sensitivity and 97.6% specificity for CECT in detection of extra-nodal disease sites.

Conclusion

PET/CT proved higher sensitivity and specificity over CECT. The major strength of PET/CT over CECT was its higher ability for detection of extra-nodal sites of lymphoma and excluding active disease in residual nodal mass lesions on follow up.     

Pattern of delayed myocardial enhancement: A key to differentiate ischemic and non-ischemic cardiomyopathies

Objective

Our objective is to find out if the pattern of delayed myocardial enhancement can be used as a key to diagnose and specify different types of cardiomyopathies.

Patients and methods

Fifty-four patients with suspected cardiomyopathy were enrolled in this study. Patients’ age ranged from 3 to 68 years. All patients were subjected to history taking, laboratory investigations, 2D echocardiography and cardiac magnetic resonance. Images were evaluated for presence, distribution, pattern and site of delayed myocardial enhancement.

Results

Seven types of cardiomyopathies were diagnosed in this study. Each type had a characteristic pattern of myocardial enhancement. Ischemic cardiomyopathy showed subendocardial up to transmural enhancement within the territory of the coronary arteries. Dilated cardiomyopathy showed midwall linear enhancement, hypertrophic cardiomyopathy showed patchy midwall enhancement and restrictive cardiomyopathy showed subendocardial circumferential enhancement. Arrythmogenic right ventricular dysplasia showed enhancement of the dilated right ventricle. Non-compaction showed enhancement of the non-compacted area. Sarcoidosis showed midwall patchy enhancement while Behcet’s disease showed right ventricular subendocardial enhancement.

Conclusion

The pattern of myocardial enhancement can be used as a key to diagnose all types of cardiomyopathies. The use of cardiac magnetic resonance in cardiomyopathy is important to quantify myocardial fibrosis as this has prognostic implications.     

A retrospective cohort study of stroke onset: implications for characterizing short term effects from ambient air pollution

Background

Androgens are crucial for normal testicular descent. Studies show that some pesticides have estrogenic or antiandrogenic effects, and that female workers exposed to pesticides have increased risk of having a boy with cryptorchidism. The main objective of the present study was to investigate whether pregnant women exposed to pesticides due to their work in horticulture experience excess risk of having sons with cryptorchidism.

Methods

We conducted a cohort study of pregnant women working in horticulture using four cohorts including one cohort established with data from the departments of occupational medicine in Jutland and Funen and three existing mother-child cohorts (n = 1,468). A reference group was established from the entire Danish population of boys born in the period of 1986-2007 (n = 783,817). Nationwide Danish health registers provided information on birth outcome, cryptorchidism diagnosis and orchiopexy. The level of occupational exposure to pesticides was assessed by expert judgment blinded towards outcome status. Risk of cryptorchidism among exposed horticulture workers compared to the background population and to unexposed horticulture workers was assessed by Cox regression models.

Results

Pesticide exposed women employed in horticulture had a hazard ratio (HR) of having cryptorchid sons of 1.39 (95% CI 0.84; 2.31) and a HR of orchiopexy of 1.34 (0.72; 2.49) compared to the background population. Analysis divided into separate cohorts revealed a significantly increased risk of cryptorchidism in cohort 2: HR 2.58 (1.07;6.20) and increased risk of orchiopexy in cohort 4: HR 2.76 (1.03;7.35), but no significant associations in the other cohorts. Compared to unexposed women working in horticulture, pesticide exposed women had a risk of having sons with cryptorchidism of 1.34 (0.30; 5.96) and of orchiopexy of 1.93 (0.24;15.4).

Conclusions

The data are compatible with a slightly increased risk of cryptorchidism in sons of women exposed to pesticides by working in horticulture.     

[6S]-5-methyltetrahydrofolate increases plasma folate more effectively than folic acid in women with the homozygous or wild-type 677C→T polymorphism of methylenetetrahydrofolate reductase

Background and purpose:

5,10-Methylenetetrahydrofolate reductase (MTHFR) is responsible for the synthesis of 5-methyltetrahydrofolate (5-MTHF). The 677C→T mutation of MTHFR reduces the activity of this enzyme. The aim of this study was, first, to compare pharmacokinetic parameters of [6S]-5-MTHF and folic acid (FA) in women with the homozygous (TT) and wild-type (CC) 677C→T mutation, and second, to explore genotype differences. The metabolism of [6S]-5-MTHF and FA was evaluated by measuring plasma folate derivatives.

Experimental approach:

Healthy females (TT, n= 16; CC, n= 8) received a single oral dose of FA (400 µg) and [6S]-5-MTHF (416 µg) in a randomized crossover design. Plasma folate was measured up to 8 h after supplementation. Concentration-time-profile [area under the curve of the plasma folate concentration vs. time (AUC)], maximum concentration (C_max) and time-to-reach-maximum (t_max) were calculated.

Key results:

AUC and C_max were significantly higher, and t_max significantly shorter for [6S]-5-MTHF compared with FA in both genotypes. A significant difference between the genotypes was observed for t_max after FA only (P < 0.05). Plasma folate consisted essentially of 5-MTHF irrespective of the folate form given. Unmetabolized FA in plasma occurs regularly following FA supplementation, but rarely with [6S]-5-MTHF.

Conclusions and implications:

These data suggest that [6S]-5-MTHF increases plasma folate more effectively than FA irrespective of the 677C→T mutation of the MTHFR. This natural form of folate could be an alternative to FA supplementation or fortification.