A Subset of Type I Conventional Dendritic Cells Controls Cutaneous Bacterial Infections through VEGFα-Mediated Recruitment of Neutrophils

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Early comparative outcomes of unicompartmental and total knee arthroplasty in severely obese patients

Background

Medial unicompartmental knee arthroplasty (UKA) may have advantages over total knee arthroplasty (TKA) in the setting of obesity. There has been no direct comparison between the two cohorts. This study compares outcomes and complications of severely obese patients undergoing medial UKA versus TKA.

Cancer detection and the community pharmacist

A questionnaire was prepared to asses community pharmacists' perceptions of their abilities to recognize the common signs and symptoms of cancer and their preferred methods for obtaining further education. Of 5,539 questionnaires mailed, 1,187 were returned and analyzed. Seventy percent of the pharmacists reported that at least one patient per month sought advice about possible cancer signs and symptoms. Almost half estimated that between 1% and 25% of the patients who had sought advice for these cancer signs and symptoms had attempted to purchase a medication to treat these symptoms. The vast majority of the pharmacists perceived that they could recognize common signs and symptoms of skin, breast, and colorectal cancers. However, the majority felt they could not identify the symptomatology for six other common cancers. Essentially all pharmacists rated education in cancer symptomatology to be important. There was no consensus as to the type of provider, format, or times for this continuing education. These data suggest that pharmacists can play an important role in the early detection and prevention of cancer. The rate of interaction by pharmacists in this study translates to more than 60,000 patients counseled about cancer symptoms per 1,000 pharmacists per year. Further education of the pharmacist in cancer detection is warranted, and appraisal of the outcome of such educational interventions on patient-referral patterns and cancer-related diagnoses is imperative.     

Descriptions of the participating centers and patient population in the Growth Failure in Children with Renal Diseases Study

The Growth Failure in Children With Renal Diseases Study, a double-blind, multicenter clinical trial with 108 children entered into the control period over 4.3 years of patient enrollment (December 1984 to April 1989), is being extended for 3 years (December 1988 to December 1991) to provide the time needed to accrue additional patients, aged between 1 1/2 and 10 years, with glomerular filtration rates of 20 to 75 ml/min/1.73 m2. The study design of randomization to two treatment arms (1,25-dihydroxyvitamin D vs dihydrotachysterol) requires a total of 108 patients with a minimum of 6 months of treatment to test the long-term effectiveness and safety of 1,25-dihydroxyvitamin D, an essential part of the therapeutic regimen for children with chronic renal insufficiency. The frequent longitudinal assessments of nutrition and growth in children with chronic renal insufficiency can better define the natural history of renal disease and its influence on growth. Similar data in the treatment period will define the impact of treatment with 1,25-dihydroxyvitamin D3 versus dihydrotachysterol on this natural history. Linear growth must be observed long enough (6 to 12 months minimum) to permit valid quantitation and comparison of the two vitamin D treatment arms, the multiple confounding variables that affect growth (e.g., steroid therapy, diabetes mellitus, prior vitamin D treatment) must be rigorously excluded or controlled, and the assignment of patients to the two groups must be random. These controls--sufficient study duration, sufficient patient numbers, and randomization--should eliminate extraneous sources of variation, including seasonal periodicity. This carefully developed, double-blind clinical trial with multiple participating centers and an effective organizational structure is coming close to achieving the goals of the study. An explosion of data regarding the natural history of chronic renal insufficiency and its treatment with vitamin D metabolites will be forthcoming at the conclusion of the study.     

Simulation of B-scan images from two-dimensional transducer arrays: Part I--Methods and quantitative contrast measurements.

Recently, theoretical investigations of the beamforming capability of two-dimensional (2-D) transducer arrays have characterized the array parameters required to steer a symmetrically focused ultrasound beam up to 45 degrees off-axis. These investigations have also shown that the number of elements in a steered 2-D array can be dramatically reduced by using a sparse set of elements, randomly distributed throughout the aperture of the transducer. The penalty paid for the use of a sparse array is the development of a "pedestal" sidelobe in the beam profile, the amplitude of which increases as the number of elements in the array decreases. In this paper the potential of 2-D arrays for medical imaging is assessed by simulating B-scan images of spherical lesions, both cystic and scattering, embedded in a large random scattering volume. Similar contrast characteristics over a range of cyst sizes are demonstrated for a dense 2-D array and a sparse array with 1/8th the number of elements, both operating at 5 MHz. A 32nd order sparse array is shown to perform at a reduced level, producing unacceptable artifactual echoes within images of cysts. The 8th order sparse array pattern has been fabricated on a fixed-focus poly(vinylidene difluoride) transducer using photolithographic techniques. Experimental images from this transducer are used to verify some of the theoretical predictions made in this paper. Comparisons between simulated B-scan images from linear and 2-D phased arrays are presented in a companion paper.     

自体骨髓干细胞移植治疗失代偿期肝硬化

选择36例失代偿期肝硬化患者,年龄37～59岁,患者在无菌条件下,从髂后上棘抽取骨髓100～200mL,在体外分离纯化骨髓干细胞后,局部麻醉下经股动脉插管经肝动脉将分离的骨髓干细胞移植于肝脏。自移植后12周,25例(69.4%)患者谷丙转氨酶逐渐降低,由平均(2788.56±357.90)nkat/L降至(1077.05±440.25)nkat/L;22例(61.1%)患者总胆红素逐渐下降,由平均(151.47±25.77)μmol/L降至(69.93±18.86)μmol/L;27例(75%)患者白蛋白逐渐升高,由平均(25.17±11.79)g/L升至(30.87±12.17)g/L。在干细胞移植后凝血酶原活动度逐渐上升,由术前平均(25.89±12.67)%上升至术后12周的(50.39±19.38)%,患者凝血机制明显改善。移植后大多数患者身体状况有明显的改善;移植后12周腹水减轻的19例(52.7%),食欲改善的28例(77.7%),体力好转20例(58.3%),腹胀减轻17例(47.2%),36例干细胞移植患者未出现严重并发症。     

Vesiculobullous Hailey-Hailey disease: Successful treatment with oral retinoids

A 56-year-old male presented with a pruritic, generalized vesiculobullous eruption. His past history revealed classical symptoms of limited Hailey-Hailey disease for 34 years. Clinically, vesicles, bullae and occasional pustules were present and multiple biopsies confirmed this to be an unusual presentation of Hailey-Hailey disease. Various therapeutic modalities including topical and oral antibiotics, oral prednisone and dapsone failed to achieve sustained remission. Treatment with lowdose oral etretinate (25 mg daily) produced marked clinical improvement with complete suppression of new vesicle formation after 6 weeks.     

Narrative language skills of maltreated children living in out-of-home care

Abstract

Purpose: Children’s narrative accounts of their experiences are central to the prosecution of perpetrators of alleged maltreatment. We describe the narrative language skills of children who were placed in out-of-home care (OOHC) following substantiated maltreatment. It was hypothesised that (i) children with such histories would display narrative language skills that fall significantly below published age-expected norms, (ii) narrative language skills and core language skills would be positively correlated and (iii) narrative language skills would be associated with measures of socio-economic disadvantage.

Method: Eighty-three children (40 males and 43 females) aged 5;3 to 12;10 (M?=?7.9, SD = 2.3) from English-speaking home backgrounds were assessed using the Test of Narrative Language and the Clinical Evaluation of Language Fundamentals (CELF-4) Core Language Score. The Raven’s Coloured Progressive Matrices, a measure of nonverbal intelligence, was employed as a covariate.

Result: Forty-two percent of children scored in the below-average range on the Narrative Language Index Ability Index. The same proportion scored at/above age-expected levels on the Narrative Comprehension subtest, and 19% scored at/above age-expected levels on Oral Narration. There was a significant correlation between CELF-4 Core Language Scores and the Narrative Language Index Ability Index. Female carers’ education was significantly positively associated with overall narrative language scores; however, household income and index of socio-economic disadvantage were not significantly associated with narrative language scores.

Conclusion: Children who are victims of substantiated maltreatment should be considered at-risk for compromised ability to provide a narrative account of their experiences. The heterogeneity and often scant oral narrative language skills of these children highlights the importance of police/human services training on best-practice forensic interviewing. Policy and practice implications for speech-language pathology early intervention to support the needs of at-risk children are also discussed.     

Magnetic resonance imaging in neuronal ceroid lipofuscinosis

Neuronal ceroid lipofuscinosis is a group of neurodegenerative disorders characterized by accumulation of lipofuscin and/or ceroid within the tissues of the body. These entities are manifest by visual, intellectual, and motor deterioration as well as recurrent seizures. Computed tomography has been shown to demonstrate changes of cerebral atrophy in more severely affected patients. Seven patients with neuronal ceroid lipofuscinosis were examined with both computed tomography and magnetic resonance imaging, and the results were correlated with the clinical severity of the disorder. Two less severely affected patients had normal results on computed tomography and magnetic resonance imaging studies. Varying degrees of cerebral atrophy were seen in the remaining five patients with both computed tomography and magnetic resonance imaging. Severity of atrophy correlated with the severity of disability in these patients. Abnormal white matter was seen in the two most severely affected patients only with magnetic resonance imaging. Although the findings in patients with neuronal ceroid lipofuscinosis were nonspecific, the increased sensitivity of magnetic resonance imaging for subtle white matter abnormalities over computed tomography may prove helpful in monitoring the progression of this rare disorder.