Doctor,What Does my Knee Arthroplasty Weigh?

The aim of this study was to compare the weight of the total knee arthroplasty (TKA) implants and the weight of the natural knee. A prospective study was conducted with two different brands of cemented primary TKA. During the procedure, we collected the removed bone, soft tissues and the post-implantation cement and weighed them all separately at the end. In both groups, the implants plus cement were significantly heavier than the removed bone and soft tissues. The average weight gained was 266.7 ± 35.1 g for group 1 and 279.1 ± 48.7 g for group 2. This significant local weight gained after TKA is a new parameter that should be taken into account for further studies and when creating new implants.     

Growth of children with end-stage renal disease undergoing daily hemodialysis

Background

The aim of this report is to describe the effect of daily hemodialysis on the growth of children with end-stage renal disease (ESRD).

Methods

We performed a prospective, observational study on 24 children with ESRD undergoing daily hemodialysis (DHD). The control group comprised 26 children on concurrent conventional hemodialysis (CHD), and the follow-up for both groups was 9.3?±?3.0 months. No patient received growth hormone (GH) therapy.

Results

At the onset of the study, the height-for-age Z-score was ?2.12?±?1.54 in the CHD group and ?2.84?±?2.27 in the DHD group (p?=?0.313). Assuming an increase of 0.5 standard deviation scores (SDS) of the height-for-age parameter as an improvement of growth, there were 33 % of patients in the DHD group and 8 % in the CHD group (p?=?0.035). The cumulative probability of gain in height for age at 12 months was 40 % in the DHD group versus 15 % in the CHD group (p?=?0.047). Also, 98 % of patients in the DHD group had an adequate total caloric intake, whereas 38 % in the CHD group reached this goal (p?<?0.001). No patient left the study due to intensification of the dialysis modality.

Conclusions

Our data show that the DHD favored a 0.5 SDS height gain in a third of patients without GH treatment. Dialysis intensification was not a cause for treatment dropouts, and DHD should be considered as a treatment for selected cases, especially small children.     

Complete pathological response to Imatinib mesylate in an extraintestinal gastrointestinal stromal tumor

INTRODUCTION

Gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumors of the digestive tract. Extraintestinal locations (EGIST) have been described showing similar pattern of immunohistochemical markers than GIST. Inhibitors of tyrosine kinases such as Imatinib or Sunitinib are the mainstay treatment in the management of advanced or metastatic GIST. Complete pathological response to these agents is an extremely rare event, especially in the case of EGIST due to its more aggressive behavior reported.

PRESENTATION OF CASE

Here we describe the case of a 61 years old woman, with an advanced GIST, who was operated after 10 months of Imatinib mesylate. The biopsy demonstrated the extra intestinal location of the tumor and a complete pathological response was confirmed.

DISCUSSION

Complete pathological response to Imatinib is a rare event. To our knowledge, this is the first report of complete response in an EGIST. New clinical, radiological and metabolic criteria of tumoral response to neoadjuvant treatment are revised.

CONCLUSION

EGIST complete pathological response to Imatinib can be achieved. However, recommendation of systematic neoadjuvant therapy with Imatinib remains investigational and more studies are warranted in the future.     

Combined measurements of N-terminal pro-brain natriuretic peptide and cardiac troponins in potential organ donors

Objective Brain death may induce cardiac dysfunction. In potential organ donors measurements of N-terminal pro-brain natriuretic peptide (NT-proBNP) and circulating cardiac troponins T and I (cTnT and cTnI), alone or in combination, are performed to investigate the accuracy of these biomarkers for early diagnosis of left ventricular systolic dysfunction. Design and setting Prospective study in a multidisciplinary intensive care unit of an university hospital. Patients 63 brain-dead patients scheduled for multiple organ harvesting. Measurements and results We measured NT-proBNP, cTnT, and cTnI and determined fractional area change (FAC) using transesophageal echocardiography. Forty-five patients had normal FAC, 9 a moderate decrease in FAC (30–50), and 9 a severe decrease in FAC (≤ 30%). NT-proBNP and cTnT concentrations were significantly higher in patients with a severe decrease in FAC than in those with a moderate decrease. Combining measurements of these two biomarkers, the sensitivity of the test to predict severe decrease in FAC increased significantly to reach 1.00 compared with the sensitivities of individual measurements. The ROC curve area of combined measurements of NT-proBNP and cTnT was significantly higher than single measurements: 0.87 vs. 0.82 for NT-proBNP, 0.78 for cTnT, and 0.72 for cTnI. Conclusions In potential organ donors the combined measurement of NT-proBNP and cTnT concentrations is more accurate than individual measurement of NT-proBNP, cTnT, and cTnI in the early diagnosis of severe left ventricular systolic dysfunction. These findings may lead to improve the quality of cardiac care of the potential organ donors.     

膀胱癌组织的傅里叶变换红外光谱研究

目的：研究傅里叶变换红外（Fourier-transform infrared，FTIR）光谱对膀胱癌组织及正常组织的分辨能力。方法：利用傅里叶变换红外光谱仪分析32对膀胱部分切除术获得的膀胱尿路上皮癌组织和相应的正常组织的中红外吸收光谱。结果：膀胱癌组织与正常组织的红外光谱具有明显的差异：（1）癌组织中与核酸相关谱带1080cm^-1和1237cm^-1的相对强度增加，表明恶性组织细胞中核酸的相对含量增加；这两个谱带的位置蓝移，表明癌组织中核酸的磷酸基团氢键遭到了破坏，使其氢键化程度降低。（2）与糖原相关的谱带1024cm^-1和1049cm^-1，在正常组织中存在着很强的吸收峰，而在肿瘤组织中几乎不出现，表明恶性细胞中的糖原被大量消耗。（3）癌组织中与蛋白质相关的酰胺Ⅰ带和Ⅱ带的吸收峰强度高于正常组织，并且氨基酸残基的C—O伸缩振动谱带出现了明显的蓝移，这些结果表明肿瘤细胞代谢旺盛，蛋白质合成增加；氨基酸大部分氢键化的C-O（H）基团的氢键被破坏，蛋白质的二级结构发生了明显变化。（4）与脂类相关的谱带1740cm^-1，2853cm^-1，2924cm^-1和2957cm^-1的吸收强度未发现有确定的规律。结论：FTIR可以快速地揭示膀胱正常组织和癌组织分子组成和结构方面所存在的差异，能够为膀胱良、恶性组织的鉴别提供可靠的信息，从而协助诊断。     

Factor analysis of quality of life, dyspnea, and physiologic variables in patients with chronic obstructive pulmonary disease before and after rehabilitation

OBJECTIVE: To identify the relationships between quality of life (QOL) and the clinical state using factor analysis pre- and postrehabilitation. Patients with chronic obstructive pulmonary disease (COPD) suffer from a significant physiologic impairment associated with an altered QOL. Comprehensive rehabilitative programs, including exercise training, have beneficial effects on exercise tolerance and QOL for these patients. DESIGN: Factor analysis (n = 6) was conducted using the data of 32 patients with COPD. Patients had been evaluated for QOL using the Nottingham Health Profile (NHP), spirometric values, dyspnea, and the variables assessed by an incremental exercise test at three levels of activity. All measurements were obtained pre- and postrehabilitation. RESULTS: Factor analysis showed that the following two factors characterize the pathophysiologic condition of patients with COPD: (1) the specific cardiorespiratory responses to incremental exercise test and the spirometric values; and (2) the QOL results. The factor analysis results differed with the testing time (pre, post) and the level of activity. CONCLUSIONS: QOL, as evaluated by a generic questionnaire and the clinical state of patients with COPD, was independent; this independence characterized the pathophysiologic condition of our patients. Our results reinforce the usefulness of different types of evaluation, especially pre- and postrehabilitation, because they reflect independent benefits used to understand the success and follow-up of rehabilitative programs.     

过滤伞在颈动脉狭窄支架术中的应用价值

目的:探索过滤伞在颈动脉狭窄支架成形术中的有效性和安全性。材料和方法:20例颈动脉狭窄行支架成形术患者,均采用过滤伞保护装置,术后短期随访。大体观察回收的过滤伞,观察围手术期间死亡、脑栓塞情况以及脑缺血事件的发生。结果:全部过滤伞成功放置,支架成形术均成功实施,回收的20个过滤伞中18个发现组织碎片,无手术死亡,无症状性脑血栓栓塞,临床短期随访均无脑缺血事件发生。结论:过滤伞能有效防止脑血栓事件的发生,在颈动脉狭窄支架成形术中是安全和有效的。     

Pain attitudes and knowledge among RNs, pharmacists, and physicians on an inpatient oncology service

Patients with cancer often experience pain, yet studies continue to document inadequate and inappropriate assessment and management of cancer-related pain. This study aimed to evaluate the attitudes and knowledge of inpatient oncology healthcare providers toward pain management by surveying nurses, pharmacists, and physicians working on the inpatient oncology units at an academic medical center. Healthcare providers generally reported positive attitudes toward pain management but were deficient in their knowledge of pain management. The authors suggest that pharmacists become more integral members of palliative care teams and actively participate in rounds. A need exists for educational programs in pain management for healthcare providers, especially for those who do not routinely care for patients with cancer.     

分层培训在神经外科护士岗位管理中的应用

本研究对神经外科护士进行分层培训,内容包括:根据护士的能级要求与专业技术等级,制定层级目标及计划;将培训的具体时间表穿插到日常工作中,理论培训与操作培训交叉进行。经过分层培训建立了有一定专业特色的护理队伍,提高了护理队伍的整体素质,提高了护士的科研能力与团队协作能力。