Phrenic Nerve Paralysis, Vegetative Symptoms and Restrictive Cardiomyopathy in a Case of Poems Syndrome

OBJECTIVE: To study the effectiveness and safety aspects of sodium valproate in the management of painful neuropathy in patients of type 2 diabetes mellitus. MATERIAL AND METHODS: A randomized double‐blind placebo controlled trial of sodium valproate was done in type 2 diabetic patients to assess its efficacy and safety in the management of painful neuropathy. We screened 60 patients but eight patients could not complete the study; hence, the present study was done on 52 patients. Each patient was assessed by clinical examination, pain score by short form of the McGill pain questionnaire (SF‐MPQ) and electrophysiological examination, which included motor and sensory nerve conduction velocity, amplitude and H‐reflex initially and at the end of 1 month of treatment. RESULTS: Significant improvement was noticed in the pain score of patients receiving sodium valproate in comparison to patients receiving placebo at the end of 1 month (P < 0.05). The changes in electrophysiological data were not significant. The drug was well tolerated by all patients except one who developed a raised aspartate transaminase (AST)/alanine transaminase (ALT) level after 15 days of treatment. CONCLUSION: Sodium valproate is a well‐tolerated drug and provides significant subjective improvement in painful diabetic neuropathy. These data provide a basis for future trials of longer duration in a larger group of patients.     

Minimal number of circulating CD34+ cells to ensure successful leukapheresis and engraftment in autologous peripheral blood progenitor cell transplantation

BACKGROUND: The number of peripheral blood (PB) CD34+ cells has been widely used to monitor the timing of leukapheresis for autologous transplantation. However, no cutoff value for CD34+ cells in PB has been defined as a guideline for the identification of patients in whom the harvest would be effective and those in whom there was a high probability of failure. STUDY DESIGN AND METHODS: The present study investigated the best threshold of CD34+ cells in PB for successful harvesting and engraftment, using 263 PB samples with their corresponding leukapheresis components. In addition, that measure has been compared to other commonly used criteria such as the white cell count, the number of mononuclear cells, and the number of colony- forming units-granulocyte macrophage in PB. RESULTS : Time to engraftment of both granulocytes and platelets was significantly influenced by the number of CD34+ cells transfused, but all patients receiving > or = 0.75 × 10(6) CD34+ cells per kg achieved engraftment within a reasonable number of days (> 0.5 × 10(9)/L granulocytes by Day 11 and > 20 × 10(9)/L platelets by Day 13). A clear correlation between the number of CD34+ cells per microL in PB and of CD34+ cells per kg collected was found at each apheresis (r = 0.9, p < 0.0001). Moreover, the number of CD34+ cells per microL measured in PB the day the first leukapheresis was initiated displayed an excellent correlation with the total amount of CD34+ cells per kg finally collected (r = 0.81, p < 0.0001). On the basis of the regression curve obtained and the clinical engraftment results, it was found that the presence of > 5 CD34+ cells per microL in PB ensured a good yield from the harvest in 95 percent of patients and would avoid an unsuccessful harvest in 81 percent of cases. CONCLUSION: A dose of only 0.75 × 10(6) CD34+ cells per kg guarantees hematopoietic recovery within a reasonable number of days. To initiate a leukapheresis from which enough progenitor cells may confidently be obtained, a minimum of 5 CD34+ cells per microL in PB is required.     

影响贫困大学生心理健康的因素分析

目的:了解影响高校贫困生心理健康的因素,以便有目的、有针对性开展心理咨询辅导工作。方法:2003-04在某高校1999/2003级共4届在校生6689人中选取436名学生作为调查对象。①观察组218名:入组条件:已接受国家助学贷款的贫困学生。该校接受助学贷款标准为:家庭经济困难(人均收入<200元/月),无力支付学费,且在接受贷款前尚未缴纳学费的学生。对照组:除外观察组学生,随机在4届学生中以班为单位整群抽样218名学生。②使用症状自评量表、抑郁自评量表、焦虑自评量表进行测评。其中症状自评量表分数越高,心理健康水平越低。以焦虑自评量表标准分≥50,抑郁自评量表标准分≥53为有焦虑抑郁症状。结果:观察组收回有效答卷213份,有效回收率为97%,对照组收回有效答卷210份,有效回收率为96%。①观察组症状自评量表总分为124.75±28.37,阳性项目数为28.05±8.64;对照组分别为125.05±27.98,26.19±16.14,两组比较差异无显著性(P>0.05)。②观察组症状自评量表中人际关系因子得分为2.18±0.45,敌对因子得分为1.29±0.35,偏执因子得分为2.04±0.26;对照组分别为1.51±0.45,1.37±0.42,1.44±0.44,两组相比差异均有显著性(P<0.05～0.001)。其他因子得分两组比较,差异无显著性(P>0.05)。③观察组焦虑自评量表粗分为28.43±5.63,标准分为35.29±6.13;抑郁自评量表粗分为29.62±6.26,标准分为37.71±8.04。对照组焦虑自评量表粗分为26.55±5.61,标准分为32.47±6.12;抑郁自评量表粗分为26.78±6.24,标准分为34.92±8.01。两组焦虑自评量表、抑郁自评量表得分均在正常范围,说明无焦虑、抑郁症状。结论:贫困大学生心理健康状况总体属正常范围;忧郁、焦虑不是主要症状;人际关系敏感和偏执是主要症状。     

星形胶质细胞对神经干细胞分化的影响

目的:研究表明,星形胶质细胞产生一系列可溶性因子和膜相关因子,对中枢神经系统的发育和功能的成熟起了重要的作用。将星形胶质细胞和神经干细胞在互不接触的情况下进行共培养,探讨星形胶质细胞对神经干细胞分化的影响。方法:实验于2005-03/2006-02在广西医科大学实验中心完成。①实验材料:生后0～2d新生SD大鼠由广西医科大学实验动物中心提供。②实验方法:分离培养新生大鼠海马神经干细胞。采用化学法、差速贴壁法和振荡法分离纯化新生大鼠脑组织星形胶质细胞,以胶质纤维酸性蛋白标记星形胶质细胞,应用免疫细胞化学染色法进行细胞纯度鉴定。将星形胶质细胞和神经干细胞在互不接触的情况下进行共培养:共培养组是将培养瓶中的星形胶质细胞用胰蛋白酶消化成单细胞悬液,加入完全培养液,待细胞均匀长满后,换神经干细胞基础培养液,孵育24h后,将涂有多聚赖氨酸的盖玻片放入6孔板中,将传代1个月的神经干细胞球种到盖玻片上,同时更换神经干细胞基础培养液继续培养。对照组是单纯接种神经干细胞球于置有多聚赖氨酸涂布盖玻片的6孔培养板内。③实验评估:采用免疫细胞化学染色法观察神经干细胞分化后神经元特异性烯醇化酶、胶质纤维酸性蛋白和酪氨酸羟化酶表达。结果:纯化的星形胶质细胞胶质纤维酸性蛋白抗体标记阳性,细胞纯度达95%。星形胶质细胞与神经干细胞共培养时,神经干细胞贴壁分化加快,神经元特异性烯醇化酶阳性细胞及酪氨酸羟化酶阳性细胞明显多于对照组(P<0.05)。结论:星形胶质细胞可诱导神经干细胞向神经元细胞,包括多巴胺神经元细胞分化,提示星形胶质细胞支持神经元发生,可能是星形胶质细胞及其分泌的因子维持并延长了神经元存活,降低了凋亡比率所致。     

Do not be alarmed,the patient is monitored

Many patients are believed to be at risk of dysrhythmias and are felt to require cardiac monitoring. These patients may not be deemed ill enough to occupy a high dependency or critical care bed and are monitored on general wards. Monitoring policies vary widely not only between institutions, but also between individual medical staff. These variations occur due to differing availability of resources and due to the lack of consensus regarding the risk for an individual patient. There is no clear evidence that monitoring patients outside high dependency areas is of benefit; inappropriate use of monitoring may actually increase patient risk.     

Transfusion-transmitted babesiosis: a case report from a new endemic area

The seventh documented case of babesiosis transmitted by transfusion is reported. Both the donor and the recipient are residents of Connecticut, where the presence of endemic babesiosis has only recently been established. As the range of Babesia microti, and its vector the Ixodes dammini tick, continues to expand, clinicians and blood bank directors should be aware that cases of transfusion-transmitted babesiosis may occur in newly endemic areas.     

Persistent low levels of serum hCG due to heterophilic mouse antibodies: an unrecognized pitfall in the diagnosis of trophoblastic disease

Phantom hCG refers to persistent mild elevations of hCG, leading physicians to unnecessary treatments whereas neither a true hCG nor a trophoblastic disease is present. We report the case of a 23-year-old woman with persistent low levels of serum hCG detected one month after miscarriage. As choriocarcinoma was suspected, a chemotherapy trial of methotrexate was prescribed, without any hCG reduction. Subsequently, laparoscopy ruled out a trophoblastic residue and the patient was referred to the Endocrine Unit for further investigations. While low levels of hCG were still detected in serum, no hCG was detected in the urine. In addition, when serum was processed in a HBT tube for revealing heterophilic antibodies, hCG was no longer detected. Such finding indicated the presence of phantom hCG due to heterophilic mouse antibodies interaction. This case raises the need of clinico-biological discussion to avoid inappropriate therapeutic decisions. Based on this case experience and after review of the literature, we suggest that current gynecological protocols for the diagnosis and treatment of trophoblastic disease should consider the inclusion of urinary hCG and/or a test for serum heterophilic antibodies when appropriate.     

护士职业压力及应对方式与工作满意度的关系

目的:分析护士职业压力、应对方式和工作满意度之间的关系。方法:于2006-02/03采用按一定护士人数比例随机抽取四川省乐山市和眉山市10所二级和三级医院的600名临床护士为调查对象进行问卷调查。①采用护士工作压力源量表调查职业压力情况,该量表分为护理工作及专业方面的问题、工作量及时间分配问题、工作环境及资源问题、患者护理方面的问题和管理及人际关系方面的问题等5个方面,共35个条目,采用1～4级评分法,分数越高,表明引起压力的程度越大。②选用肖计划编制的应付方式问卷调查护士的应对方式,该问卷包括解决问题、合理化、求助、自责、幻想、退避六种类型,共有62个条目,每个条目有"是"或"否"两个答案。③采用自编的护士工作满意度问卷调查护士对工作的满意程度,该问卷包括工作成就感、人际关系、专业发展、工作条件和福利待遇5个因素,共16个条目,采用1～5级评分法,分数越高,表明对工作的满意程度越高。对结果数据进行相关分析、回归分析和结构方程分析。结果:发放问卷600份,回收有效问卷530份,有效率为88.3%。从护士职业压力、应对方式和工作满意度的关系模型中分析发现:职业压力中各因素对工作满意度均有显著性的影响。护理专业及工作方面对工作满意度既有直接的非常显著的负向预测作用,也通过退避方式间接影响工作满意度;管理与人际关系通过合理化、退避等方式对满意度产生间接的负向作用;工作环境及资源通过解决问题等方式对满意度产生间接的正向作用;工作量及时间分配既可直接对满意度产生负向作用,也通过退避和解决问题方式间接影响工作满意度;患者护理对满意度产生直接的正向作用。在应对方式中,解决问题方式对工作满意度有直接的正向预测作用,而退避对满意度有直接的负向预测作用;其他几种应对方式均是通过退避或解决问题间接影响满意度(模型所有的路径系数均>0.05,达到显著水平)结论:护士职业压力不同,应对方式存在差异;应对方式不同,工作满意度也不同;职业压力既可以直接影响工作满意度,也可以通过应对方式间接影响工作满意度。     

腰神经根受压模型大鼠神经根局部炎症因子对温和灸的反应

目的:观察温和灸对腰神经根受压模型大鼠受压神经根局部炎症因子白细胞介素1和白细胞介素6的调节作用,并与灌胃给药莫比可相比较。方法:实验于2005-09/2006-04在上海第六人民医院实验中心完成。①分组:将40只SD大鼠随机分为4组,正常对照组,模型对照组,温和灸组及莫比可组,每组10只。②方法:温和灸组、莫比可组、模型对照组通过手术建立大鼠腰神经根压迫模型,正常对照组做与以上各组相同的捆绑固定,不予手术。温和灸组穴位选取受压神经根相应节段右侧的夹脊穴,采用精制清艾条以穴位为中心、半径为5mm的区域进行温和灸,20min/次,1次/d,7次为1个疗程,共治疗14次。莫比可组按3.75mg/kg灌胃莫比可(10mL生理盐水含药物5mg),每天灌胃1次。正常对照组及模型对照组:生理盐水灌胃10mL/kg,每日灌胃1次。于治疗14d后麻醉下处死取受压神经根组织。③评估:于光镜下观察受压神经根组织形态学变化;用免疫组织化学技术检测神经根局部炎症因子白细胞介素1、白细胞介素6水平。结果:40只大鼠均进入结果分析。光镜下观察温和灸组神经节细胞、神经纤维结构基本正常,见极少量炎细胞。与模型对照组相比,温和灸组与莫比可组神经根局部炎症因子白细胞介素1、白细胞介素6的含量有不同程度的减少(P<0.05);温和灸治疗组白细胞介素1、白细胞介素6的水平低于莫比可组(P<0.01)。结论:温和灸及西药莫比可均能有效抑制神经根局部炎症因子分泌,其中温和灸作用迅速,其效果明显优于莫比可。