Crystalloid preload versus rapid crystalloid administration after induction of spinal anaesthesia (coload) for elective caesarean section

Current methods of crystalloid preload administration prior to spinal anaesthesia for elective caesarean section are relatively ineffective in preventing hypotension. This study examined the relevance of the timing of the fluid administered. Fifty women were randomly allocated to receive either 20 ml x kg(-1) of crystalloid solution during 20 minutes prior to induction of spinal anaesthesia (preload), or an equivalent volume by rapid infusion immediately after induction (coload). Significantly more patients in the coload group did not require vasopressor therapy pre-delivery (P=0.047). The coload group required a lower median dose (P=0.03) and a lower median number (P=0.04) of ephedrine doses for the treatment of maternal hypotension pre-delivery. There was no between-group difference in either the total cumulative dose, or in the total number of doses of ephedrine. Neonatal outcomes among the two groups were similar. Rapid crystalloid administration after, rather than over 20 minutes before the induction of spinal anaesthesia for elective caesarean section, may be advantageous in terms of managing maternal blood pressure prior to delivery.     

Parapharyngeal lymph node metastasis: an unusual presentation of papillary thyroid carcinoma

BACKGROUND: Parapharyngeal space nodal metastases are usually secondary to malignancies of the pharynx and sinonasal tract, although localization of lymphomas is also possible. Parapharyngeal metastases arising from thyroid papillary carcinoma are instead an exceedingly rare event, with only 10 cases reported up to now in the literature. METHODS: We describe two cases of parapharyngeal metastasis from thyroid papillary carcinoma in a man and a woman, aged 40 and 52 years, respectively. RESULTS: Both patients had a lesion that clinically appeared to be located in the parapharyngeal space; they underwent CT and MRI, which detected a cystic mass in the poststyloid compartment. In the first patient, fine-needle aspiration cytology failed in identifying the histologic nature of the lesion, which was excised through a transcervical approach. A diagnosis of metastatic thyroid papillary carcinoma was rendered and therefore the patient underwent total thyroidectomy. In the second patient, a total thyroidectomy, previously scheduled for multinodular goiter, was performed along with the removal of the parapharyngeal mass. Definitive histologic findings revealed that the two parapharyngeal masses were cystic metastases from a thyroid papillary carcinoma. Both patients received postoperative 131I treatment. Twenty-four months after surgery, the first patient is free of disease, whereas the second one has clear signs of abnormal 131I uptake in the lungs. CONCLUSIONS: The differential diagnosis of a parapharyngeal poststyloid mass should also include metastasis from thyroid papillary carcinoma. When the lesion displays a cystic appearance on imaging, it is advisable to rule out a thyroid primary by ultrasonographic examination. The occurrence of a metastasis in such unusual site, even though rarely reported, does not seem to significantly affect the prognosis of the disease.     

Molecular bilateral symmetry of natural products: prediction of selectivity of dimeric molecules by density functional theory and semiempirical calculations

A literature survey and theoretical calculations have been applied to explore bilateral symmetry in natural product systems. Molecular bilateral symmetry is defined to include C(2) (sigma plane or axis), C(s)(), and C(2)(v)() point groups in molecules. Natural products that possess chirality in the form of C(2)-axes or sigma planes of symmetry are present in higher proportions (69%) compared to molecules bearing achiral C(s)() or C(2)(v)() point groups (14% and 16%, respectively). Density functional theoretical and semiempirical calculations indicate that the dimers 3,3'-dibromo-5,5'-[N-(2-(3-bromo-4-hydroxyphenyl)ethyl)-2-hydroxyiminoacetamide]biphenyl-2,2'-diol (1), (S,S)-1,2-bis(2-amino-3H-imidazol-4-yl)-(R,R)-3,4-bis(1H-pyrrole-2-amido)cyclobutane (2), 2-oxo-dimethyl-1,3-bis(3,4-dibromobenzene-1,2-diol) (11), 1,7-bis(4-hydroxy-3-methoxyphenyl)hepta-1,6-diene-3,5-dione (12), and bis(5-isopropyl-8-methylazulene)methane (13) evolve more energy per connecting bond than the corresponding trimers or tetramers would. This we propose is a guiding parameter that may adjust molecule growth. The corresponding trimers, tetramers, or higher oligomers of 1, 2, and 11-13 appear to represent "missing" compounds in nature. Natural products 1, 2, and 11-13, having 3-fold and higher levels of symmetry, would founder on the lack of a facile method of synthesis and on the prohibitively high-energy costs caused by steric crowding at their core.     

A new method for the extraction and classification of single motor unit action potentials from surface EMG signals

It has been shown that multi-channel surface EMG allows assessment of anatomical and physiological single motor unit (MU) properties. To get this information, the action potentials of single MUs should be extracted from the interference EMG signals. This study describes an automatic system for the detection and classification of MU action potentials from multi-channel surface EMG signals. The methods for the identification and extraction of action potentials from the raw signals and for their clustering into the MUs to which they belong are described. The segmentation phase is based on the matched Continuous Wavelet Transform (CWT) while the classification is performed by a multi-channel neural network that is a modified version of the multi-channel Adaptive Resonance Theory networks. The neural network can adapt to slow changes in the shape of the MU action potentials. The method does not require any interaction of the operator. The technique proposed was validated on simulated signals, at different levels of force, generated by a structure based surface EMG model. The MUs identified from the simulated signals covered almost the entire recruitment curve. Thus, the proposed algorithm was able to identify a MU sample representative of the muscle. Results on experimental signals recorded from different muscles and conditions are reported, showing the possibility of investigating anatomical and physiological properties of the detected MUs in a variety of practical cases. The main limitation of the approach is that complete firing patterns can be obtained only in specific cases due to MU action potential superpositions.     

Effects of aminoguanidine and cyclooxygenase inhibitors on nitric oxide and prostaglandin production, and nitric oxide synthase and cyclooxygenase expression induced by lipopolysaccharide in the estrogenized rat uterus

BACKGROUND/OBJECTIVE: The aim of our study was first to investigate if there exists an interaction between nitric oxide (NO) and prostaglandin (PG) generation in the estrogenized rat uterus challenged by lipopolysaccharide (LPS), and, secondly, which isoforms of nitric oxide synthase (NOS) and cyclooxygenase (COX) participate in this process. METHODS: To study the effect of LPS and to characterize the isoenzymes involved in the process, specific inhibitors of iNOS (aminoguanidine) and COX-II (meloxicam, nimesulide) and non-specific of COX (indomethacin) were injected intraperitoneally to determine their effect on NO and PG production, and on NOS and COX expression induced by LPS in estrogenized rat uterus. NO production was measured by arginine-citrulline conversion assay and PGE(2)/PGF(2alpha,)by radioconversion. Enzyme expression was evaluated by Western blot analysis. RESULTS: The present work shows that iNOS inhibitor, aminoguanidine, reduced NO and PGE(2)/PGF(2alpha) production induced by LPS injection. Aminoguanidine exerts its effect over the PG metabolism by inhibiting COX-II activity and expression. On the other hand, both indomethacin, a non-selective PG inhibitor, and meloxicam, a COX-II inhibitor, stimulated NO production and reduced PGE(2)/PGF(2alpha) generation. Indomethacin also reduced COX-II and iNOS expression. CONCLUSION: These results indicate that in the estrogenized rat uterus challenged with LPS, PG and NO interact affecting each other's metabolic pathways. The above findings indicate that the interaction between NOS and COX might be important in the regulation of physiopathologic events during pregnancy.     

Clinical improvement and serum amino acid levels after mud-bath therapy

Spa therapy is an ancient approach to degenerative diseases such as osteoarthritis, but until today this tradition has been predominantly empiric and intuitive and few studies have focused on the biological changes derived from this treatment. We assessed the clinical efficacy and variations in amino acid concentrations in serum samples from patients with knee osteoarthritis who underwent spa therapy and put forward an explanation of their role in clinical improvement. Thirty-one patients with knee osteoarthritis who underwent spa therapy underwent a clinical evaluation, and serum amino acid levels were assayed before and after a cycle of balneotherapy and mud-pack therapy. The thermal treatments were carried out in Sciacca. Analysis of the data showed a significant reduction in pain and improvement in joint motility. Serum concentrations of tryptophan, cysteine and citrulline were significantly higher than at baseline. No significant differences were observed in serum levels of the remaining free amino acids. The results of this study confirm the efficacy of spa therapy in the treatment of osteoarthritis. A possible role for changes in serum amino acid concentration is discussed.     

Evaluation of bone mass in young amenorrheic women with anorexia nervosa

BACKGROUND: In the last 10 years an impressive increase in the frequency of food disorders (bulimia and anorexia) in teenagers has been recorded. Food disorders, present especially in girls, (part of more complex relational-familiar disorders) cause progressive repercussions on the general endocrine structure and in particular on the reproductive system of the subject. The most visible effect of this endocrine perturbation is the block of the ovarian function with secondary amenorrhoea and low levels of gonadotropins and estrogens due to the food disorder. In fact the qualitative and quantitative food deficit is responsible for the interruption of the normal hypothalamic and pituitary pulses regulating the correct monthly process of follicular growth. As in the physiological postmenopausal period, very low plasma levels of 17-b-estradiol (<30 pg/ml) can start the bone resorption with bone loss and/or osteoporosis related to the amount and the time of exposure to low levels of estrogens. Objectives: in our study we evaluate the influence of anorexia and amenorrhoea on bone mineral density. METHODS: We evaluate bone mineral density (BMD) with computerised bone mineralometry (MOC), a dual-energy-X-Ray (DEXA), in 18 women with anorexia nervosa and weight loss, 9-12 months amenorrhoea and with low plasma levels of 17-b-estradiol. The BMD was measured at the lumbar spine (L2-L4) and on total body in all subjects enrolled for this study. RESULTS: All the patients showed a decrease on the lumbar BMD with bone loss (49%) or osteoporosis (51%). On the other side the values of total body BMD were around the normal levels (86%) or showed bone loss (14%). CONCLUSIONS: Our data support the hypothesis that lower estrogenic levels associated with anorexia nervosa have an impact on BMD, especially at lumbar level, with early incidence for quantitative and qualitative lower food intake.     

Down syndrome and cell-free fetal DNA in archived maternal serum

OBJECTIVE: Increased levels of cell-free fetal DNA (f-DNA) in the maternal circulation are a potential noninvasive marker for fetal Down syndrome. Our objectives were to (1) determine whether f-DNA could be quantified by using archived serum and amniotic fluid, (2) examine whether serum f-DNA levels are elevated in Down syndrome pregnancies in a case-control series matched for gestational age and duration of sample storage, and (3) determine whether f-DNA levels are elevated in the amniotic fluid of Down syndrome fetuses. STUDY DESIGN: Eleven serum and six amniotic fluid samples previously collected and stored at -20 degrees C from gravid women carrying a 47,XY,+21 fetus were each paired with five matched control samples of identical specimen type from gravid women carrying a presumed euploid male fetus. f-DNA concentration was quantified blindly by real-time polymerase chain reaction amplification for a Y-chromosome sequence. Matched rank-sum analysis and analysis of variance were used for analysis. RESULTS: The mean observed rank of 5.0 in the Down syndrome group was significantly higher than expected (P 相似文献