MR findings in iatrogenic Gerbode defect

Congenital or acquired communication between left ventricle and right atrium is rare and can be easily overlooked as an eccentric tricuspid regurgitation jet. MRI is the ideal modality for accurate diagnosis, providing details for surgical planning about the location and size of the defect.     

老年大鼠松质骨骨重建的组织形态计量学研究

目的：研究老年大鼠及在促骨合成药前列腺素E2（PGE2）作用下松质骨骨重建和骨建造的形态计量学改变，探讨动物骨重建形态学新参数测量方法及其意义。方法：50只20月龄雄性Wistar大鼠随机分成5组，年龄对照组（基础组、10d和30d年龄对照组），PGE2给药组（分别10d和30d给予3mg/kg/d处理组）。用体内双荧光标记，不脱钙组织切片，粘合线（cement line）染色，骨组织形态计量学方法，测定骨重建和骨建造参数。结果：20月龄雄性大鼠胫骨近端松质骨的形成表面大多数为骨重建单位（占63．3％），少部分为骨建造单位（占26．7％）；PGE2用药后骨重建单位增加1．5倍，骨建造单位增加4倍，比值倒置，成骨细胞10d时明显增多。说明PGE2通过刺激成骨细胞骨合成而介民导骨建造性骨增加和骨重建性骨量增加，并以前为主。结论：老年雄性大鼠 松质骨以骨重建活动为主，仍有骨建造活动。PGE2主要通过刺激成骨细胞骨建造而增加骨量。     

Melatonin and prostate cancer cell proliferation: interplay with castration,epidermal growth factor,and androgen sensitivity

BACKGROUND: Potential modulatory effects of melatonin on the proliferation of androgen-sensitive LNCaP and androgen-insensitive PC-3 and DU 145 prostate cancer cells were reported recently. In this study, we investigated the effects of combined melatonin and castration on LNCaP tumor growth in vivo, the interactions between melatonin and epidermal growth factor (EGF) on LNCaP cell proliferation, and melatonin actions on the proliferation of PC-3 and DU 145 cells. METHODS: Tumor development and growth in castrated nude mice inoculated with LNCaP cells or in intact animals inoculated with DU 145 cells, with or without daily melatonin treatment, were monitored by observation and caliper measurement. MT(1) receptor expression in native or transfected prostate cancer cell lines was examined by immunocytochemistry or 2-[(125)I]iodomelatonin binding. Cyclin D1 expression in LNCaP cells was assessed by Western blotting, and cell proliferation was measured by thymidine incorporation and/or cell count. RESULTS: Melatonin treatment was associated with further decreases in LNCaP tumor incidence and growth rate in castrated nude mice. Melatonin and 2-iodomelatonin (a melatonin receptor agonist) attenuated EGF-stimulated increases in LNCaP cell proliferation and cyclin D1 levels. Melatonin had no effect on the proliferation or growth of MT(1) receptor-expressing DU 145 cells, and of PC-3 cells in which MT(1) receptor protein was undetectable. The proliferation of transfected PC-3 cells expressing MT(1) receptor was unaffected by 2-iodomelatonin. CONCLUSION: Together with previous data, the present results indicate synergistic action of melatonin and castration in inhibiting the growth of androgen-sensitive LNCaP tumor. Androgen-sensitive prostate cancer cell proliferation may be modulated by opposite changes in cyclin D1 levels induced by activated MT(1) and EGF receptors. In androgen-insensitive prostate cancer cells, MT(1) receptor-mediated signal transduction may become defective not only through changes in membrane receptor protein expression and/or functions, but also by means of alterations in downstream postreceptor signaling events.     

Laparoscopic antireflux surgery in the lung transplant population

BACKGROUND: Lung transplantation has emerged as a viable therapeutic option for patients with a variety of end-stage pulmonary diseases. As immediate posttransplant surgical outcomes have improved, the greatest limitation of lung transplantation remains chronic allograft dysfunction. Gastroesophageal reflux disease (GERD) with resultant aspiration has been implicated as a potential contributing factor in allograft dysfunction. GERD is prevalent in end-stage lung disease patients, and it is even more common in patients after transplantation. We report here on the safety of laparoscopic fundoplication surgery for the treatment of GERD in lung transplant patients. METHODS: Eighteen of the 298 lung transplants performed at Duke University Medical Center underwent antireflux surgery for documented severe GERD. The safety and benefit of laparoscopic fundoplications in this population was evaluated. RESULTS: The antireflux surgeries included 13 laparoscopic Nissen fundoplications, four laparoscopic Toupets, and one open Nissen (converted secondary to extensive adhesions). Two of the 18 patients reported recurrence of symptoms (11%), and two others reported minor GI complaints postoperatively (nausea, bloating). There were no deaths from the antireflux surgery. After fundoplication surgery, 12 of the 18 patients showed measured improvement in pulmonary function (67%). CONCLUSIONS: GERD occurs commonly in the posttransplant lung population. Laparoscopic fundoplication surgery, when indicated, can be done safely with minimal morbidity and mortality. In addition to the resolution of reflux symptoms, improvement in pulmonary function may be seen in this population after fundoplication. Lung transplant patients with severe GERD should be strongly considered for antireflux surgery.     

Treatment of Soft Tissue Contour Defects by a Combination of Surgical Subcision with a Beaver Tympanoplasty Blade and Autologous Fat Grafting

This report describes a technique for treating depressed scars and soft tissue contour deformities. Surgical subcision with a Beaver tympanoplasty blade is undertaken for depressed or adherent scars to release the fibrous attachments beneath the scar before autologous fat grafting. Satisfactory results were observed, with an improvement in surface contour for 16 patients over a 3-year period. The authors recommend the described technique as a safe, minimally invasive, and precise method for subcutaneous dissection of scar tissue before fat injections.     

Are there anatomical barriers to laparoscopic donor nephrectomy?

Background: The aim of this study was to analyse the effect of the right donor kidney and multiple arteries, on donor and recipient outcomes in the era of laparoscopic live donor nephrectomy (LLDN). Methods: We retrospectively analysed the 200 donors and recipients who underwent a planned laparoscopic nephrectomy at two hospitals between September 1998 and December 2006. The impact of donor right kidney and multiple donor renal arteries on operative time, hospital stay, graft function, and donor and recipient complications were analysed. Results: Of the total cohort (n = 200), 140 (70%) were classified as Simple LLDN (left live donor kidney with single renal artery). The Complex LLDN group (n = 60) contained all right‐sided kidney (n = 28) and left‐sided kidneys with multiple renal arteries (n = 32). Baseline characteristics, extraction time, conversion to open, length of admission, overall graft function and complication rates were similar between the simple and complex groups. The second warm ischaemic time in the Simple LLDN group was slightly shorter than the Complex LLDN group (32 versus 36 min P = 0.016). The 1‐month post‐operative recipient serum creatinine level was lower in the Simple LLDN group when compared with the Complex LLDN group (117 versus 125 µmol/L P = 0.025). There was no difference in post op dialysis, acute rejection within 3 months or graft survival between the Simple and Complex LLDN groups. Conclusion: Laparoscopic procurements of right kidneys and kidneys with multiple arteries were safe and yielded kidneys with excellent function comparable with those of laparoscopic left donor nephrectomy with single artery.     

Nutrient intake and psychological health in an elderly Chinese population

BACKGROUND: Associations between nutrition and cognitive impairment, and nutrition and depression, have been observed. Elderly people are at risk of under nutrition, and also have higher prevalence of cognitive impairment and depression. OBJECTIVE: To examine the relationship between nutrient intake and psychological health in the elderly, adjusting for confounding factors. SUBJECTS: Three thousand nine hundred and ninety-nine men and women aged 65 years and over living in the community, with approximately equal numbers in three age groups: 65-69, 70-74, 75+ years. METHODS: Dietary intake was assessed using a 7-day food frequency questionnaire. Cognitive function was assessed by the cognitive part of the Community Screening Instrument for Dementia (CSID). Depression was assessed using the Geriatric Depression Scale (GDS). Information was also collected for confounding factors: demographics, educational level, socioeconomic status, medical history, smoking, alcohol intake, and physical activity. Logistic regression analyses were carried out to examine associations between lifestyle and dietary variables, and CSID and GDS, controlling for confounders. RESULTS: Both CSID and GDS scores were associated with co-morbidity, demographic and socioeconomic factors. Few associations between lifestyle factors and CSID score were observed. Dietary factors inversely associated with GDS score include total fat intake, vitamins A, B2, B3, C, fibre, and vegetables. In terms of nutrient density, iron and isoflavone intake were additional factors. CONCLUSION: Association exists between intake of various nutrients and psychological health independent of other confounding factors in the elderly population. A follow-up study of this cohort or interventional studies are needed to elucidate cause effect relationship.