Role of ultrasound therapy in the healing of tibial stress fractures

Background: Stress fracture is the single most common cause for the lost number of manpower days during training. The conventional treatment options begin with rest and cessation of precipitating activity. However the demands of military training provide little tolerance for prolonged periods of rest. In the recent past ultrasound therapy (UST) has been reported to speed up healing of stress fractures.     

黄芪植入可控降解胶原支架控释促血管生成的效应

目的：将中药黄芪载入胶原支架内,通过对胶原支架进行修饰,观察黄芪能否代替生长因子起到促进血管生成疗效,并了解黄芪与生长因子是否有协同作用. 方法：实验于2004-07-01/2006-07-01在德国亚琛工业大学生化研究所及江苏省中医院中心实验室进行.首先通过不同的EDC/NHS与肝素钠比例来交链修饰Ⅰ型胶原（EDC与NHS质量比固定为1∶0.6,EDC与肝素钠比例为0.2～4）,然后将1 mL黄芪注射液（相当于3 mg生药黄芪）载入修饰后的胶原内.体外通过甲苯胺蓝法测定修饰后胶原内肝素含量,胶原酶降解法测量胶原体外降解率,同时对胶原的亲水性及自由氨基团进行测定.体内通过鸡胚绒毛尿囊膜模型进行血管计数及血红蛋白测定. 结果：①体外实验结果：通过对胶原的修饰程度,可以控制胶原内的肝素含量、体外降解率、自由氨基团含量、亲水性大小.②体内实验结果：黄芪注射液1 mL载入修饰后的胶原较载入未修饰的胶原,可以明显促进鸡胚绒毛尿囊膜内微血管生成,提高胶原内血红蛋白含量（P＜0.01）,其疗效与重组人体血管内皮生长因子载入修饰后的胶原内相当,且与血管内皮生长因子有协同作用的趋势. 结论：通过对胶原的修饰来控制胶原的体外降解,载入黄芪后,使黄芪促血管生成疗效增强,达到与血管内皮生长因子载入后的疗效相当,其作用机制有待进一步研究.     

Single‐port laparoscopic cholecystectomy: A comparative study in 106 initial cases

Introduction: Laparoscopic cholecystectomy has been the standard of care for gallbladder diseases since the late 1980s. Many surgeons have rapidly adopted single‐port laparoscopic cholecystectomy for gallbladder pathologies. The aim of the present study was to analyze the clinical outcome in initial single‐port laparoscopic cholecystectomy. Methods: Data from 106 consecutive single‐port laparoscopic cholecystectomies between May 2008 and April 2009 were analyzed retrospectively. We divided the patients into two groups – an early group (group I, n=56) and a late group (group II, n=50) – to compare clinical outcomes. During each procedure, only one longitudinal transumbilical incision, 1.5 to 2.0 cm in length, was made to access the abdominal cavity. A multichannel port system was assembled with existing devices. Standard laparoscopic instruments were used to perform each cholecystectomy. Results: Patient demographics did not differ between the two groups. Of the eight cases that were converted to conventional laparoscopic surgery, seven were part of group I (P=0.063). Mean operation time for single‐port laparoscopic cholecystectomy was significantly shorter in group II (58.2 versus 71.6 min, P=0.004). There were two operative complications in group I, which were successfully managed with laparoscopic surgery. There was no statistical difference in occurrence of operative complication and hospital stay between the two groups. Conclusion: Single‐port laparoscopic cholecystectomy can be safely performed for various gallbladder lesions in selected cases, and the operation time improved with accumulation of cases.     

Expression of mdr-1 in refractory lymphoma: quantitation by polymerase chain reaction and validation of the assay [published erratum appears in Blood 1995 Dec 15;86(12):4710]

Measurement of P-glycoprotein and the gene that encodes it, mdr-1, is an important tool for assessing the impact of multidrug resistance in clinical cancer. We evaluated mdr-1 expression by a quantitative polymerase chain reaction (PCR) assay in 78 biopsy samples from 48 patients with refractory lymphoma enrolled on a trial of infusional chemotherapy (EPOCH) in which R-verapamil was added as an antagonist of P-glycoprotein in a subset of patients whose tumors were unresponsive to treatment. Expression of mdr-1 was detectable in all biopsies at the time of enrollment on study, and a fourfold or greater increase in mdr- 1 expression was noted in 42% of patients at the time of treatment failure. Expression of mdr-1 was also detectable in biopsies from patients at the time of diagnosis of lymphoma. An endogenous control gene, beta 2-microglobulin, was quantitated for normalization of the mdr-1 values. The use of beta 2-microglobulin expression for normalization was validated in a subset of samples by comparing Northern blots detecting beta 2-microglobulin, beta actin, and GAPDH gene expression. Immunoblot analysis suggested that no major discrepancy was present between mRNA expression and protein level. Immunophenotyping of lymphomatous lymph nodes showed that infiltration of tumor cells ranged from 8% to 95% and of normal T cells from 1% to 83%. Expression of mdr-1 in normal T cells and monocytes was also shown to be low. The mdr-1 levels in patient samples were independent of T- cell contamination, suggesting that the presence of normal cells has at best a small impact on mdr-1 measurements. Expression of mdr-1 in lymphoma can be quantitated by PCR, and wide variations in expression can be observed. Increased expression in patients with refractory disease supports an important role for Pgp in drug resistance in lymphoma. These studies will aid in the design and interpretation of clinical trials in lymphoma.     

MISDIAGNOSES IN A CHINESE NARCOLEPTIC PATIENT WITH DELAYED ONSET OF CATAPLEXY

Narcolepsy is a chronic condition that usually afflicts the patient for decades. It is more common than is generally appreciated. However, it is likely to be misdiagnosed because doctors are unfamiliar with some of the symptoms. Its significant socioeconomic impact on the patient's quality of life warrants prompt medical attention.     

消旋棉酚拆分的研究——Ⅲ.胺缩棉酚理化性质的研究

本文报道消旋棉酚与15种不同结构的光学活性胺缩合产物的薄层色谱性质和核磁共振氢谱数据,以及8个光学活性胺与光学活性棉酚缩合物的光学稳定性,并探讨了结构与这些性质的关系。     

Significance of Tuberculin Testing in HIV Infection: An Indian Perspective

Background

Tuberculin skin testing (TST) is a reliable tool in the diagnosis of tuberculous infection and is important in its control. However, it may be false negative in immunocompromised patients like HIV-infected.

Methods

We examined the pattern of TST results in 523 newly diagnosed HIV-positive patients. CD4, CD8 and absolute lymphocyte counts were done by flowcytometry in 63 of these cases.

Results

56 (44.10%), 15 (11.81%) and 56 (44.10%) of the 127 cases with tuberculosis and 293 (73.99%), 41 (10.35%) and 62 (15.66%) of the 396 cases without any clinical evidence of tuberculosis showed TST results of 0-4, 5-9 and = or > 10 mm respectively. Significantly more (P<0.05) number of cases with TST of = or > 10mm and significantly lesser (P<0.05) number of cases with TST of 0-4 mm are likely to develop tuberculosis. The average CD4+lymphocyte count was found to be significantly lower in cases with nil TST results than with = or >10mm. HIV infected cases associated with tuberculosis with induration on TST had average CD4 counts of 129.5 as compared to 246.3/cmm in those without tuberculosis.

Conclusion

In India where both these diseases are endemic, tuberculosis may develop during early HIV infection, while the body''s immunity is still largely unimpaired and TST shows = or >10mm results in almost 45% of our cases. In another 45% with TST of 0-4mm, the CD4+ lymphocyte count is likely to be lower than 200/cmm. In those with nil induration, TST of 5-9 mm cannot be taken as an independent marker for suspecting tuberculosis in the HIV infected. Hence we recommend that all cases with TST of = or >10mm and cases with nil induratrion with CD4+ count of <200/cmm should be considered as high-risk for developing tuberculosis.Key Words: Tuberculin skin test, HIV infection     

Vulvar basal cell carcinoma: clinical features and treatment outcomes from a tertiary care centre

We retrospectively reviewed the clinical features, management and outcomes of patients diagnosed with basal cell carcinoma (BCC) of the vulva at the Gynaecological Cancer Centre, KK Women’s and Children’s Hospital, Singapore, between 1 January 2000 and 28 February 2014. Patients with vulvar BCC were identified from the cancer registry, and their medical records reviewed and analysed. A total of 11 patients with vulvar BCC were identified. Mean age at diagnosis was 63 (range 30–85) years. Ethnically, ten patients were Chinese and one was Malay. Average time from onset of symptoms to diagnosis was 13.8 (range 2–60) months. The most common presenting symptoms were lump and pruritus. All patients were managed surgically. Recurrence was noted in only one patient. Vulvar BCC, although rare, has an excellent prognosis when managed appropriately. Histological diagnosis of all persistent papules, plaques and pigmented lesions is important for early diagnosis.     

大鼠肠系膜淋巴微循环在急性微循环障碍时的变化

目的:采用局部滴加肾上腺素造成大鼠肠系膜微循环障碍模型,观察急性微循环障碍时淋巴微循环的变化。方法:实验于2006-04/07在河北北方学院医学院病理生理实验室完成。①实验分组:Wistar雄性大鼠20只,随机分为肾上腺素组和生理盐水组,每组10只。②实验方法:肾上腺素组依次由低浓度向高浓度用微量灌流泵从肠系膜局部滴加给药,给药浓度为0.1,1,10mg/L,速度为15滴/min,,每次给药间隔为30min;生理盐水组,在肾上腺素组的相对应时间肠系膜滴加生理盐水。两组大鼠在滴加后5min进行指标测量。③实验指标:测量急性微循环障碍时大鼠肠系膜淋巴管最大舒张口径、最大收缩口径和静态口径;记录大鼠肠系膜淋巴管收缩频率、收缩期时间、舒张期时间;计算大鼠肠系膜淋巴管收缩活性指数、总收缩活性指数、淋巴动力学指数。结果:20只大鼠均进入结果分析。①肠系膜淋巴管口径:给药前,肾上腺素组与生理盐水组肠系膜淋巴管静态口径、最大收缩口径及最大舒张口径组差异无显著性(P>0.05),肠系膜滴加不同浓度肾上腺素后,淋巴管静态口径、最大舒张口径小于给药前及生理盐水组(P<0.05),而生理盐水组淋巴管口径无明显变化。②肠系膜淋巴管收缩周期:活体淋巴微循环观察可见肠系膜淋巴管呈自主节律性收缩,平均收缩频率为(4.50±1.08)次/min,肠系膜滴加肾上腺素后,淋巴管收缩频率及舒张期时间明显低于给药前及生理盐水组(P<0.05)。③肠系膜淋巴管收缩指数:给药前,肾上腺素组肠系膜淋巴管收缩活性指数、总收缩活性指数、淋巴动力学指数与生理盐水组比较差异无显著性(P>0.05)。肠系膜滴加不同浓度肾上腺素后,3个收缩性指数明显低于给药前及对照组水平(P<0.05),而滴加生理盐水后,收缩指数无明显变化。结论:急性微循环时大鼠肠系膜淋巴微循环明显障碍。