Brighton合作组关于Guillain-Barré综合征的诊断定义和资料收集规范

Guillain-Barr啨综合征(GBS)和Miller Fisher综合征(MFS)的诊断标准随着临床研究的深入在不断演变。2011年1月,《疫苗》杂志发表了国际疫苗安全性监测Brighton合作组关于GBS/MFS的诊断定义和研究资料收集规范。此文献中未采用"诊断标准"而采用"诊断定义"是因为其主要目的为评价疫苗安全性而制定,而非用于神经科的GBS/     

A systematic review of population health interventions and Scheduled Tribes in India

Background  

Despite India's recent economic growth, health and human development indicators of Scheduled Tribes (ST) or Adivasi (India's indigenous populations) lag behind national averages. The aim of this review was to identify the public health interventions or components of these interventions that are effective in reducing morbidity or mortality rates and reducing risks of ill health among ST populations in India, in order to inform policy and to identify important research gaps.     

NEWER CONCEPTS AND MANAGEMENT OF NEONATAL SEPSIS

Despite extensive research into its patho-physiology, investigations and treatment, sepsis remains an important cause of neonatal morbidity and mortality. The incidence in developing countries is 10 times that in the developed world. A large number of pro-and anti-inflammatory cytokines (interleukins, eicosanoids, tumour necrosis factor-alpha, nitric oxide) have been identified, the interplay of which leads to the Systemic Inflammatory Response Syndrome (SIRS) which can have devastating consequences on all systems of the body. In India the common organisms include Staphylococcus, E coli, Klebsiella and Candida. A number of maternal and neonatal risk factors have been identified. The initial signs and symptoms are subtle and can easily be missed. Early investigations and screening tests are important and a promising number of new tests are being studied. The gold standard for diagnosis is a positive culture from a body fluid or local source in the presence of SIRS. The threshold for starting antibiotics should be low in high-risk neonates and broad spectrum antibiotics covering the likely organisms should be given intravenously in all suspected cases in a hospital setting. This should be continued for at least 24-48 hours (till negative reports are available) in suspected cases and for 2-3 weeks in proven cases. Prophylaxis is aimed at preventing nosocomial and cross infections. Strict hand-washing, meticulous asepsis protocols, identification of high risk groups and prompt and better screening tests are essential in controlling this problem.KEY WORDS: Neonate, Sepsis, Systemic inflammatory response syndrome     

A combination of misoprostol and estradiol for preoperative cervical ripening in postmenopausal women: a randomised controlled trial

Objective  To compare the impact of 1000 μg of self-administered vaginal misoprostol versus self-administered vaginal placebo on preoperative cervical ripening after 2 weeks of pretreatment with estradiol vaginal tablets in postmenopausal women prior to day-care operative hysteroscopy.
Design  Randomised, double-blind, placebo-controlled sequential trial.
Setting  Norwegian university teaching hospital.
Population  Sixty-seven postmenopausal women referred for day-care operative hysteroscopy.
Methods  The women were randomised to receive either 1000 μg of self-administered vaginal misoprostol or self-administered vaginal placebo on the evening before day-care operative hysteroscopy. All women had administered a 25-μg vaginal estradiol tablet daily for 14 days prior to the operation.
Main outcome measures  Primary outcome: preoperative cervical dilatation at hysteroscopy. Secondary outcomes: difference in dilatation at recruitment and before hysteroscopy, number of women who achieved a preoperative cervical dilatation of 5 mm or more, acceptability, complications and adverse effects.
Results  The mean cervical dilatation was 5.7 mm (SD, 1.6 mm) in the misoprostol group and 4.7 mm (SD, 1.5 mm) in the placebo group, the mean difference in cervical dilatation being 1.0 mm (95% CI, 0.2–1.7 mm). Self-administered vaginal misoprostol of 1000 μg at home on the evening before day-care hysteroscopy is safe and highly acceptable, although a small proportion of women experienced lower abdominal pain.
Conclusions  One thousand micrograms of self-administered vaginal misoprostol, 12 hours prior to day-care hysteroscopy, after 14 days of pretreatment with vaginal estradiol, has a significant cervical ripening effect compared with placebo in postmenopausal women.     

Limited posterior thoracotomy for the correction of intra cardiac anomalies–current perspectives

Background Though the use of median stermotomy has been fairly standardized for the approach to the heart and great vessels, since the advent of cosmetically appealing incisions, thoracotomy has come to be a justifiable alternative incision. This paper presents our experience with this approach and the advantages over the conventional approach as well as over other incisions for the correction of intra-cardiac anomalies. Methods 93 patients underwent open cardiac procedures using the posterior thoracotomy approach since June 1997 to December 2000. There were 69 patients with ostium secundum atrial septal defects and 12 patients with sinus venous defects. Other anomalies included perimembranous ventricular septal defects in 3 patients, partial atrioventricular septal defects in 3 patients and transitional atrioventricular septal defects in 2 patients. Besides these, one patient each underwent atrial septectomy with right modified Blaloc—Taussing shunt and correction of hemianomalous pulmonary venous connection with intact atrial septum using this approach. The median age of the patients was 8 years with a range of 10 months to 41 years. 10 patients were males. Results The median operation time (skin to skin) was 236 minutes. Median bypass times and aortic cross clamp times were 63 minutes and 31.5 minutes respectively. The median ICU stay was 25.2 hours. There were no significant immediate post operative complications requiring intervention in any patient. The mean chest drainage was 80 ml per 24 hours. One patient had a superficial wound dehiscence which healed with daily dressings One patient had atelectasis of the right upper lobe which recovered with chest physiotherapy. All patients are on regular follow up to assess the status of their scars. One patients developed a mass on the right atrial free wall following closure of atrial septal defect one year earlier and the underwent reoperation for removal of the mass. Patients on follow up were interrogated and all were satisfied with the cosmesis of their scars. None of the patients had any physical disability due to their scars. Conclusions The limited posterior thoracotomy incision offers a cosmetically attractive approach to the heart in selected patients. The approach is easy and the techniques reproducible. The technique carries with it no additional risk and has the advantage of not interfering with future development of the breast in young pre pubertal girls.     

Kimura disease of the eyelid in an Indian man

Kimura disease is a rare idiopathic chronic inflammatory disease, characterized by subcutaneous nodular lesions in the head and neck area. Ophthalmic manifestation of Kimura disease involves orbital and eyelid lesions mostly in Asian patients, but it has been described in White patients and Black Caribbean patients. Kimura disease is usually associated with eosinophilia and occasionally with renal disease. Here, we report a case of Kimura disease of the eyelid in a 50-year-old Indian man with eosinophilia. The main differential diagnosis was angiolymphoid hyperplasia with eosinophilia. Histology is crucial to separate these two entities, and our case was shown to be Kimura disease by histology. To our knowledge, this is the first report of a person of Indian origin to develop Kimura disease involving the eyelid.     

腺病毒载体介导的PML生长抑制因子对前列腺癌细胞生长和致瘤能力的抑制效果

为探讨用腺病毒载体携带ＰＭＬ（ＰｒｏｍｙｅｌｏｃｙｔｉｃＬｅｕｋｅｍｉａ）基因作为前列腺癌基因治疗的可能性，应用重组人携带ＰＭＬ基因腺病毒（ＡｄＰＭＬ）感染培养的前列腺癌细胞，观察表达ＰＭＬ蛋白的癌细胞与对照组癌细胞的体外生长和裸鼠体内致瘤能力变化，对荷瘤裸鼠瘤体周围注射ＡｄＰＭＬ，观察治疗组和对照组肿瘤生长的变化。结果显示，感染ＡｄＰＭＬ的前列腺癌细胞体外生长和裸鼠体内致瘤能力明显下降，荷瘤裸鼠瘤体周围注射ＡｄＰＭＬ后肿瘤生长速度明显减慢。证实了ＰＭＬ是一种生长抑制因子，提示其可能被应用于前列腺癌的基因治疗研究