Pulmonary embolism,part II: Management

Acute pulmonary embolism (PE) bears a significant burden on health and survival. Rapid and accurate risk stratification and management are of paramount importance to ensure the highest quality of care. This present article summarizes currently available and emerging management strategies for the disease. The authors not only review current evidence regarding early therapy of acute PE, including supportive care, anticoagulation, thrombolysis, surgical and catheter-based treatment, but also the possible role of mechanical circulatory support in PE. The authors also discuss complications related to PE and its management.     

Molecular pathology in real time

With the development of sophisticated individualized therapeutic approaches, the role of pathology in classification of tumors is enormously increasing. The solely morphological characterization of neoplastic process is no more sufficient for qualified decision on optimal therapeutic approach. Thus, morphologic diagnosis must be supplemented by molecular analysis of the lesion with emphasis on the detection of status of certain markers used as predictive factors for targeted therapy. Both intrinsic and acquired types of intratumor heterogeneity have an impact at various moments of cancer diagnostics and therapy. The primary heterogeneity of neoplastic tissue represents a significant problem in patients, where only limited biopsy samples from the primary tumor are available for diagnosis, such as core needle biopsy specimens in breast cancer, transthoracic or endobronchial biopsies in lung cancer, or endoscopic biopsies in gastric cancer. Detection of predictive markers may be influenced by this heterogeneity, and the marker detection may be falsely negative or (less probably) falsely positive. In addition, as these markers are often detected in the tissue samples from primary tumor, the differences between molecular features of the primary lesion and its metastases may be responsible for failure of systemic therapy in patients with discordant phenotype between primary and metastatic disease. The fact of tumor heterogeneity must be taken into consideration already in establishing pathological diagnosis. One has to be aware that limited biopsy specimen must not always be fully representative of the entire tumor volume. To overcome these limitations, there does not exist one single simple solution. Examination of more tissue (preference of surgical resection specimens over biopsies, whenever possible), use of ultra-sensitive methods able to identify the minute subclones as a source of possible resistance to treatment, and detection of secondary molecular events from the circulating tumor cells or circulating cell-free DNA are potential solutions how to handle this issue.     

The role of computerized tomography in the diagnosis of regional metastases of cancer of the esophagus and the proximal part of the stomach]

Computed tomography (CT) findings were compared with operative ones for 50 patients with esophageal and proximal gastric cancer. In diagnosis of metastases to the upper abdominal and retroperitoneal lymph nodes ST sensitivity reached 93.3%, specificity 85% and accuracy 90.3%. The best diagnostic results were obtained in detection of metastases to the nodes of the celiac trunk branch and paraaortal fat (94.2%). Lower CT resolution appeared in diagnosis of perigastric node metastatic involvement in the primary tumor location in the proximal stomach.     

G418抗性HEK293细胞的培育

目的　培育具有G418抗性的HEK2 93细胞 ,用于建立猪内源性反转录病毒感染人HEK2 93细胞的模型。方法　通过脂质体转染的方法 ,将含有neo基因的质粒pIRESneo导入HEK2 93细胞中 ,利用G418的选择特性 ,对转染细胞进行压力筛选 ,并对其进行了PCR鉴定。结果　经 6 0 0 μg ml的G418压力筛选后 ,获得了抗性细胞克隆。抗性细胞的形态和生长速度与筛选前细胞没有差异 ,特异性核苷酸引物检测抗性细胞基因组DNA ,可以扩增出对应的核苷酸片段。结论　成功地培育了G418抗性HEK2 93细胞 ,为建立猪内源性反转录病毒感染人HEK2 93细胞的模型奠定了基础。     

碳水化合物对牛体外受精胚胎体外发育的影响

目的　在SOF +PVA(合成输卵管液 +聚乙烯醇 )这一化学成分明确培养系统条件下 ,观察了葡萄糖、丙酮酸和乳酸三种碳水化合物对牛体外受精胚胎体外发育的影响 ,以便为今后进一步探讨影响牛早期胚胎体外发育的因素提供实验依据。方法　牛卵母细胞体外成熟和体外受精后 ,在化学成分明确培养系统内进行体外发育培养。结果　实验 1将牛体外受精卵培养于不含有葡萄糖的SOF +PVA培养系统中 ,培养 12 0h后分别移入含有 0、1 5 0、3 30、5 0 0mmol L的SOF +PVA培养系统中 ,对照组胚胎一直在含有 1 5 0mmol L葡萄糖的SOF +PVA中培养 ,结果囊胚的发育率分别为 9 2 % a、12 1%、19 2 % b、18 9%和 11 7% (a 相似文献   

Perinatal care in the Soviet Union: a time of transition

Recent Soviet reforms in health care policy and financing are expected to have a significant impact on perinatal services. Efforts are under way to upgrade the care of pregnant and birthing women. This paper describes some aspects of the current system of perinatal care and prospects for future change.     

Hypocalcaemia may reduce the beneficial effect of magnesium treatment in aneurysmal subarachnoid haemorrhage.

To assess whether magnesium treatment in patients with subarachnoid haemorrhage (SAH) is associated with hypocalcaemia and whether hypocalcaemia in these patients is associated with an increased risk of delayed cerebral ischemia (DCI) and poor outcome. All 137 patients randomized in the clinically controlled "Magnesium in Aneurysmal Subarachnoid Haemorrhage" trial were included. The relationship between mean serum magnesium and mean serum calcium during treatment was assessed with linear regression. The relationship between hypocalcaemia (serum calcium < 2.0 mmol/L) during treatment and the occurrence of DCI and poor outcome was studied with the Cox proportional hazards method and logistic regression, respectively. There was a statistically significant inverse relation between elevated serum magnesium and hypocalcaemia (B = -0.27; 95% CI, -0.33 to -0.20; p < 0.001). Patients with hypocalcaemia during study treatment had an increased frequency of DCI (HR 2.1; 95% CI, 1.0 to 4.3), and an increased risk for poor outcome (OR 2.9; 95% CI, 1.4 to 6.4), but this effect attenuated in the multivariable analysis (OR 1.9; 95% CI, 0.8 to 4.7). In conclusion, prolonged elevated serum magnesium is associated with hypocalcaemia. Hypocalcaemia is associated with an increased risk of DCI and poor outcome and may therefore reduce the potential beneficial effect of magnesium treatment in SAH.     

骨髓基质成骨细胞与煅烧骨联合培养的实验研究

目的:探索煅烧骨(calcined bone calcium,CBC)作骨组织工程支架材料的可行性。方法:将CBC分纤维粘连蛋白修饰组和单纯培养液修饰组,分别与骨髓基质成骨细胞(marrow stromal osteoblast,MSO)于体外联合培养,进行扫描电镜观察和碱性磷酸酶活性检测,了解细胞在材料中的粘附、生长、增殖、分泌及材料与细胞的相互作用情况。结果:经系统处理过的CBC具有类似原骨的三维结构。体外培养12h细胞已贴附于CBC支架,复合培养7d,分布在支架上的细胞迅速分化增殖,分泌细胞外基质和矿化结节。碱性磷酸酶测定7d组的活性显著高于12h组活性(P<0.01)。两组之间扫描电镜观察和碱性磷酸酶测定均未见明显差异(P>0.05)。结论:CBC生物相容性好,不需作修饰即能促进成骨细胞的粘附、增殖、分泌活动,是骨组织工程的理想支架材料。     

Hemodynamic effects of chronic 4′ epi-adriamycin administration

Summary Adriamycin (ADM) is an effective antineoplastic drug. However, the amount of ADM that can be administered must be limited because of the risk of developing a severe dose-dependent cardiomyopathy. 4Epi-adriamycin (4 ADM) is a new anthracycline analog with similar antineoplastic properties as ADM, but with perhaps less cardiac toxicity. To determine myocardial performance after a chronic treatment with 4ADM, we studied 17 patients (mean age 36.6 years) suffering from lymphomas by means of 24-hour ambulatory ECG, x-ray, M-mode echocardiogram, and rest-exercise gated radionuclide ventriculography (RNV), performed prior to and 2 months after the end of the treatment. Pretreatment and post-treatment shortening fractions, basal pretreatment and post-treatment ejection fractions, and postexercise pretreatment and post-treatment ejection fractions, were tested for correlation with individual 4ADM doses and pretreatment with ADM. No association was noted among them, showing the lack of correlation between doses and impairment of ventricular performance. 4ADM doses ranged from 400 to 1100, 748±174 mg/m²; allnoninvasive studies including RNV doses and RNV (Pearson's correlation coefficient, p=ns). No deterioration of ventricular performance could be demonstrated. Conversely, the basal pretreatment ejection fraction changed from 56.17±7.6% to 61.52±8.3% in posttreatment (p<0.0001). Surprisingly, the postexercise pretreatment ejection fraction also increased from 55.47±7.7% to 63.35±10% in post-treatment (p<0.03). The shortening fraction changed from 35.47±4.8% to 36.47±4.2% after 4ADM treatment (ns). No impairment of cardiac function could be shown in patients previously treated with ADM or radiotherapy. On the basis of these data, treatment with 4ADM did not impair but improved cardiac function