螺旋CT增强扫描在胆囊癌诊断中的价值

目的探讨螺旋CT多期增强扫描在胆囊癌诊断中的作用。方法对23例经病理证实的胆囊癌患者的多期螺旋CT表现进行回顾性分析。结果胆囊癌主要CT表现为胆囊壁的不规则增厚和结节状突起以及胆囊内的肿块，增强扫描强化明显且持续时间长。结论螺旋CT多期增强扫描在胆囊癌的定性诊断及了解胆囊癌的侵犯范围上具有重要作用。     

周期蛋白G1反义硫代脱氧寡核苷酸对白血病细胞增殖的调控

为了探讨脂质体转染细胞周期蛋白(cyclin)G1反义脱氧寡核苷酸(ASON)对HL-60细胞增殖调控的作用，用针对cyclin G1 mRNA5′端编码区起始密码子(ATG／AUG)的ASON，通过脂质体导入HL-60细胞共培养后，用免疫组织化学法和RT-PCR分别检测cyclin G1和mRNA水平的表达，用电镜、细胞原位凋亡检测法(POD)、流式细胞术(FCM)及DNA凝胶电泳等方法检测细胞凋亡。结果表明：cyclin G1 ASON组与SON及空白对照组相比，ASON能特异地抑制cyclin G1及mRNA水平的表达，当ASON的浓度达到一定程度时，HL-60细胞的增殖及集落形成率均明显受抑制，出现细胞凋亡，并且此作用随ASON浓度的升高而增强。结论：cyclin G1的特异反义脱氧寡核苷酸能封闭其蛋白及mRNA水平的表达，对白血病细胞的增殖有抑制作用，并可促使细胞凋亡，且有浓度依赖性。     

Service utilisation and costs of language impairment in children: The early language in Victoria Australian population-based study

Purpose: To examine (1) the patterns of service use and costs associated with language impairment in a community cohort of children from ages 4–9 years and (2) the relationship between language impairment and health service utilisation.

Method: Participants were children and caregivers of six local government areas in Melbourne participating in the community-based Early Language in Victoria Study (ELVS). Health service use was reported by parents. Costs were valued in Australian dollars in 2014, from the government and family perspectives. Depending on age, the Australian adapted Clinical Evaluation of Language Fundamentals – Pre-school, 2nd Edition (CELF-P2) or the CELF, 4th Edition (CELF4) was used to assess expressive and receptive language.

Result: At 5, 7 and 9 years respectively 21%, 11% and 8% of families reported using services for speech and/or language concerns. The annual costs associated with using services averaged A$612 (A$255 to government, A$357 to family) at 5 years and A$992 (A$317 to government, A$675 to family) at 7 years. Children with persistent language impairment had significantly higher service costs than those with typical language.

Conclusion: Language impairment in 4–9-year-old children is associated with higher use of services and costs to both families and government compared to typical language.     

Commentary on the safety of red cells preserved in extended-storage media for neonatal transfusions

Red cells preserved in extended-storage media are the standard product dispensed by many regional blood centers. When the red cells are intended for neonatal transfusion, concern exists about the safety of the relatively high quantities of additives present in these media. Definitive studies to address these concerns are not available. Therefore, to estimate the effects of additives and to delineate circumstances in which they might be harmful, the quantities transfused in defined clinical settings were calculated, and the following recommendations are offered for transfusing infants less than 4 months of age. First, red cells preserved in extended-storage media should present no substantive risks when used for small-volume (approximately 10 mL/kg) transfusions of premature infants and can be used without additional processing. Second, the risks of the most premature neonatal patients or those with severe renal and/or hepatic insufficiency cannot be defined clearly, and, because data are not available to ensure safety for these infants, removal of the additive medium and resuspension of the red cells in saline or albumin solution immediately before transfusion are recommended. Third, following a similar rationale, it seems prudent to avoid using entire units of red cells preserved in extended-storage media in massive transfusion settings (e.g., exchange transfusion, cardiac surgery, and extracorporeal membrane oxygenation). In these settings, the preservative medium should be removed and the red cells resuspended in the fluid that is most appropriate for the procedure that is planned. It must be emphasized that these recommendations are based on calculations and hypothetical settings, not actual data. Accordingly, they are tentative and should be altered as definitive information becomes available.     

Can the reading for serologic reactivity following 37 degrees C incubation be omitted?

The need to detect antibodies that agglutinate and/or hemolyze red cells (RBCs) directly at 37 degrees C, but do not react in subsequently performed indirect antiglobulin tests (IATs), is of concern relative to the streamlining and automation of antibody detection methods. To determine incidence and significance of such reactions, data from 87,480 tests, which used low-ionic-strength saline, 10-minute incubation at 37 degrees C, and anti-IgG, were analyzed for unexpected antibodies. There were 3590 positive tests, of which 475 showed reactions at 37 degrees C but not in subsequently performed IATs (37 + IAT-). Of these, 196 reactions were due to autoantibodies or other factors usually considered insignificant with respect to the survival of transfused incompatible RBCs, 176 were due to alloantibodies of questionable clinical significance (M, Lea, P1, etc.), and 103 were associated with alloantibodies of potential clinical significance (63 E, 27 K, 5 Jka, 4 D, 3 cE, and 1 C). This latter reaction was seen in 72 patients, with two 37 + IAT-antibodies occurring in each of 3 patients. Of the 75 potentially significant 37 + IAT-antibodies, 57 were seen in patients recently exposed to homologous RBCs, 13 in patients with a history of transfusion and/or pregnancy, and 5 in patients with no known exposure to homologous RBCs. IAT reactivity was observed in subsequent samples with 27 of these antibodies. The predictive value of a 37 + IAT-test was 21.7 percent for a potentially significant antibody. The incidence was 0.12 percent of all tests for unexpected antibodies.(ABSTRACT TRUNCATED AT 250 WORDS)     

Percutaneous umbilical blood sampling and umbilical vein transfusions. Rapid serologic differentiation of fetal blood from maternal blood

Percutaneous umbilical blood samples (PUBS), obtained under ultrasound guidance, are used for prenatal diagnosis and management of hemolytic disease of the newborn (HDN) and other fetal disorders. Rapid testing at the time of sampling is vital to distinguish fetal from maternal blood. Blood typing was performed by slide technique in the treatment room during 38 procedures on 25 patients. Anti-I was used to test 50 presumed PUBS; venous I-positive maternal blood was tested in parallel. Because anti-I cannot detect fetal blood after umbilical vein transfusion (UVT) of I-positive donor blood, ABO and Rh blood typing reagents were used to test 29 samples when maternal and fetal or donor blood groups differed. Monoclonal reagents were used for optimal detection of weak AB antigens in fetal blood. Avid, chemically modified anti-D was used for Rh typing. Blood typing showed 27 (34%) of 79 samples to be maternal blood. Fetal blood was obtained in 8 of 10 cases investigated for fetal disorder and in 16 cases of potential HDN (anti-D, 5; -CD, 5; -cE, 2; -K, 2; -c; -E). The absence of HDN (antigen-negative fetus) was determined in 4 cases. UVT afforded live birth of 9 of 10 infants with HDN and was not indicated in two cases.     

Nationwide survey of home transfusion practices

BACKGROUND: Limited information exists on home transfusion practices. STUDY DESIGN AND METHODS: In 1995, a survey requesting data for 1994 was sent to 1273 American Association of Blood Banks (AABB) institutional members and 113 non-AABB home health care agencies that provide out-of-hospital transfusions. RESULTS: Of 943 respondents, 102 provide blood to a home transfusion program, 37 provide blood and run a home transfusion program, and 13 run a home transfusion program only, for a total of 152 (16%) with some involvement in home blood transfusions. Most of the 50 respondents with a home transfusion program are licensed by their state and accredited by the Joint Commission on Accreditation of Healthcare Organizations. All respondents have written policies for home transfusion, and 90 percent require a signed informed-consent document before initiating transfusions in the home. Most have policies requiring that there be a second adult and a telephone in the home, that the home be deemed safe for transfusion, that the patient's physician be readily available, and that the patient have had prior transfusions. The most common component issued by the blood providers was red cells, followed by platelets. White cell-reduced components were always provided by 36 percent of respondents. The most common patient diagnosis was cancer. Home transfusions were provided primarily by registered nurses. Only 14 percent of respondents indicated that the medical director of the blood bank is responsible for approving a patient for home transfusion. A posttransfusion visit is performed by 46 percent of respondents. CONCLUSION: Although most facilities have policies for the administration of home transfusions, there remains marked heterogeneity among blood providers and transfusionists regarding home transfusion practices.     

Performance of a Radiation Protection Cabin During Implantation of Pacemakers or Cardioverter Defibrillators

Radioprotection for Cardiac Device Implant . Introduction: Pacemaker implants are associated with a high cumulative exposure of the operators to radiation. Standard radiation protection with lead aprons is incomplete and the cause of spine disorders. A radiation protection cabin offers complete protection by surrounding the operator, without requiring a lead apron. Methods: We randomly and evenly assigned 60 patients undergoing implantations of permanent pacemakers or cardioverter defibrillators (ICD) with (a) a radiation protection cabin (cabin group, n = 30) versus (b) standard protection with a 0.5 mm lead‐equivalent apron (control group, n = 30). Radiation exposure was measured using personal electronic dosimeters placed on the thorax, back, and head of the operator. Results: The patient, procedural, and device characteristics of the 2 study groups were similar. All procedures in the cabin group were performed as planned without increase in duration or complication rate compared with the control group. The mean radiation dose to the head, normalized for fluoroscopy duration, was significantly lower in the cabin (0.040 ± 0.032 μSv/min) than in the control (1.138 ± 0.560 μSv/min) group (p < 0.0001). The radiation doses to the thorax (0.043 ± 0.027 vs 0.041 ± 0.040 μSv/min) and back (0.038 ± 0.029 vs 0.033 ± 0.018 μSv/min) in the cabin versus control group (under the apron) were similar. Conclusions: The use of a radiation protection cabin markedly decreased the exposure of the operator to radiation, and eliminated the need to wear a lead apron, without increasing the procedural time or complication rate during implantation of pacemaker and ICD. (J Cardiovasc Electrophysiol, Vol. 21, pp. 428–430, April 2010)     

大鼠慢性牙周炎与慢性肾衰竭模型的建立及相关性研究

目的 用SD大鼠建立慢性牙周炎（CP）和慢性肾衰竭（CRF）动物模型,探讨两种疾病是否相关。 方法 将40只健康雄性SD大鼠随机分为4组,每组10只：正常对照组、CP组、CRF组和CP＋CRF组。于8周末处死动物,检查记录牙周指标,检测血清中血肌酐（Scr）、尿素氮（BUN）、白细胞介素（IL）1β、肿瘤坏死因子（TNF）α的含量,观察牙周和肾脏组织病理学改变,进行统计学分析。 结果 成功建立了CP和CRF动物模型。CP＋CRF组Scr（120.54±21.29） μmol/L, BUN（34.20±14.44） mmol/L;CRF组Scr（93.63±18.82） μmol/L,BUN（17.77±4.15） mmol/L,两组间差异有统计学意义（P < 0.05）。肾脏病理显示,CP组肾组织出现炎性改变,CP＋CRF组肾脏炎细胞浸润,PAS、Masson染色评分与CRF组差异有统计学意义。牙周病理显示,CP组、CP＋CRF组出现明显牙周炎,CP＋CRF组附着丧失（AL）（173.60±16.75）μm,CP组AL（124.00±23.87） μm,两组差异有统计学意义（P < 0.05）。CP组、CRF组、CP＋CRF组血清IL-1β、TNF-α水平显著高于正常对照组 （P < 0.05）,CP＋CRF组IL-1β显著高于CP组、CRF组（P < 0.05）,CP＋CRF组TNF-α水平高于CP组、CRF组,且与CP组差异有统计学意义（P < 0.05）。2×2析因设计方差分析结果显示,CP与CRF对Scr、BUN、AL的数值具有交互作用（P < 0.05）,且两因素各自对上述指标的主效应显著（P < 0.05）;CP与CRF对IL-1β、TNF-α的数值不具有交互作用（P > 0.05）,但两因素各自对IL-1β、TNF-α的主效应显著（P < 0.05）。 结论 本模型可在SD大鼠同时显现牙周炎和慢性肾衰竭,CP可加重肾衰竭,两者间有相关性,CP可能通过炎性机制加重肾脏的损害。     

Levels of (1→3)-β-D-glucan, <Emphasis Type="Italic">Candida</Emphasis> mannan and <Emphasis Type="Italic">Candida</Emphasis> DNA in serum samples of pediatric cancer patients colonized with <Emphasis Type="Italic">Candida</Emphasis>species

Background  

Surveillance cultures may be helpful in identifying patients at increased risk of developing invasive candidiasis. However, only scant information exists on the effect of Candida colonization on serum levels of diagnostic biomarkers. This prospective surveillance study determined the extent of Candida colonization among pediatric cancer patients and its possible impact on serum levels of (1-3)-β-D-glucan (BDG), Candida mannan and Candida DNA.