Grade I hydronephrosis: pulsed Doppler US evaluation

This study was undertaken to determine whether the presence of blood vessels could mimic the appearance of grade I hydronephrosis on sonograms and thus cause false-positive readings. One hundred consecutive patients with grade I hydronephrosis were examined. Sample volumes were obtained with pulsed Doppler ultrasonography (US) at the site of the greatest separation of the central renal sinus echoes to determine if the separation was fluid accumulating in the collecting system, as in obstruction, or if the separation was actually caused by vessels that mimic hydronephrosis. Vascular structures accounted for the separation of the sinus echoes in 43% of patients. In patients 12 years of age or younger, this frequency rose to 61%. The simple procedure of evaluating the renal sinus echo separation with pulsed Doppler US should decrease the frequency of false-positive diagnoses of hydronephrosis and thus diminish the need for further confirmatory testing.     

Acute and long-term effects of massive balloon dilation on the aortic wall and vasa vasorum

To investigate the acute and long-term effects on the vasa vasorum after massive overdilation, canine aortic segments were dilated with Gruentzig balloon catheters to more than 100% over normal size. In the acute study, the significant lumen increase was the result of intimal and medial rupture with stretching and thinning of the adventitia. In these areas, the vasa vasorum were stretched and severed, causing adventitial hemorrhage. In the chronic study, areas of previous subtotal wall rupture with adventitial thinning were repaired by scar tissue. This repair included formation of a neomedia, hyperplasia of the adventitia, and proliferation of the vasa vasorum. No progression of luminal dilatation was seen. This study showed that in subtotal aortic wall rupture, even a severely damaged adventitia is capable of preserving the lumen from further dilatation and rupture until healing. Blood flow to the damaged vessel wall was reestablished by revascularization via capillary budding in the aortic wall.     

Influence of CT on radiologic utilization in The Netherlands

The authors studied the influence of computed tomography (CT) on radiologic utilization in The Netherlands. Twenty-six hospitals with a CT scanner were compared with 27 hospitals without on the basis of number of radiologic procedures per clinical patient from 1977 to 1984. Changes in average length of hospitalization were also considered. The number of procedures decreased in hospitals with CT scanners (-9%), in contrast to hospitals without (+10%). The influence of CT on average length of stay appeared minimal. Although this study was limited, the authors believe that use of CT influenced changes in radiologic utilization.     

On the mechanism of the effects of potassium restriction on blood pressure and renal sodium retention

Dietary potassium restriction increases sodium and chloride retention, whereas potassium administration promotes both diuresis and natriuresis. In epidemiologic and clinical studies, potassium intake is inversely related to blood pressure and is lower in blacks than in whites. The present studies examined the mechanism by which potassium restriction fosters sodium conservation and the impact of race on this response. Twenty-one healthy black and white men and women ingested an isocaloric, potassium-restricted diet (20 mmol/d) containing 180 mmol/d of sodium with and without a potassium supplement (80 mmol/d) for 9 days on two occasions. Additionally, eight of these subjects ingested the same diets for 3 days followed by a water load to determine free water clearance before and during the early phase of dietary potassium restriction. During potassium restriction, mean arterial pressure (MAP) derived from 24-hour blood pressure measurements was higher (85.7 +/- 1.6 mm Hg v 82.0 +/- 1.3 mm Hg; P < 0.001), cumulative sodium excretion lower (984 +/- 59 mmol/d v 1,256 +/- 58 mmol/d; P < 0.001), and weight greater (71.1 +/- 2.1 kg v 69.3 +/- 2.2 kg; P < 0.001). Blacks displayed no greater increase in MAP, although they excreted less sodium overall and less potassium on the potassium-supplemented diet. After a water load, minimum urine osmolality (Uosm) was lower (53.0 +/- 3.0 mOsm/L v 65.6 +/- 3.5 mOsm/L; P = 0.01) and free water clearance greater (4.44 +/- 0.59 mL/min v3.72 +/- 0.58 mL/min; P = 0.009) during potassium restriction. In conclusion, in healthy, normotensive subjects, potassium restriction was associated with an increase in blood pressure and volume expansion effected by increased renal sodium and chloride retention. Potassium restriction was also associated with increased free water clearance and enhanced diluting capacity consistent with augmentation of Na+, K+:2Cl- cotransporter activity in the thick ascending limb of Henle. This mechanism may play an important role in the renal adaptation required for potassium conservation, but at the expense of sodium chloride retention and an elevation in blood pressure.     

胰岛素受体介导主要信号传导途径与胰岛素抵抗的治疗进展

目的:了解胰岛素受体介导的主要的信号传导途径与胰岛素抵抗的关系,总结胰岛素抵抗的药物治疗方法。方法:主要选择被Medline收录的外文文献和在国内核心杂志上发表的有关文献,就其内容进行分析、分类、归纳及总结。结果:胰岛素受体、胰岛素受体底物、磷脂酰肌醇-3-激酶及葡萄糖转运蛋白4信号传递关键分子受损是导致胰岛素抵抗的主要原因。α糖苷酶抑制剂、双胍类、噻唑烷二酮类药物等纠正胰岛素信号传导通路中的障碍,增加靶组织对胰岛素敏感性的措施,都是胰岛素抵抗的治疗方法。结论:胰岛素信号转导途径的任何一个环节受损均可导致胰岛素抵抗。影响胰岛素受体介导的信号传导的新药开发将成为改善胰岛素抵抗的新趋向。     

Systemic levels of interleukin-6 and matrix metalloproteinase-9 in patients with multiple myeloma may be useful as prognostic indexes of bone disease.

Multiple myeloma is characterized by accelerated production of the proteolytic enzyme matrix metalloproteinase (MMP)-9. We hypothesized that myeloma-produced MMP-9 may influence the rate of bone turnover in a paracrine manner. Thus, we examined the correlations of MMP-9 levels, disease severity, and bone turnover rate as evaluated by markers of bone formation and resorption. Thirty-seven newly diagnosed multiple myeloma patients (nine of Durie-Salmon stage I, 12 of stage II and 16 of stage III) and 12 age-matched controls were studied. Serum MMP-9 levels were significantly higher at stage II compared to stage I (188.78+/-91.27 vs. 59.25+/-33.09 ng/mL, p<0.004). Additionally, free urine pyridinolines (F-Pyd), free urine deoxy-pyridinolines (F-Dpd) and urine N-telopeptide fragment (NTx) were elevated, their level correlating with disease stage (p<0.001, p<0.03, p<0.001, respectively), as were bone marrow infiltration and serum interleukin-6 (IL-6) levels (p<0.0001, p<0.01, respectively). MMP-9 levels were lower in patients compared with controls (p<0.001), whereas IL-6 and bone resorption marker levels were higher in patients than in controls (p<0.001 in all cases). Significant correlation was found between infiltration, MMP-9, free urine pyd, free urine dpd and NTx for each stage of the disease (p<0.03, p<0.003, p<0.002, p<0.003 and p<0.001, respectively). Levels of MMP-9 and of IL-6 in multiple myeloma correlate well with bone turnover rate and may be useful in disease evaluation.     

The Angelina Jolie effect: how high celebrity profile can have a major impact on provision of cancer related services

Introduction

It is frequent for news items to lead to a short lived temporary increase in interest in a particular health related service, however it is rare for this to have a long lasting effect. In 2013, in the UK in particular, there has been unprecedented publicity in hereditary breast cancer, with Angelina Jolie’s decision to have genetic testing for the BRCA1 gene and subsequently undergo risk reducing mastectomy (RRM), and a pre-release of the NICE guidelines on familial breast cancer in January and their final release on 26^th June. The release of NICE guidelines created a lot of publicity over the potential for use of chemoprevention using tamoxifen or raloxifene. However, the longest lasting news story was the release of details of film actress Angelina Jolie’s genetic test and surgery.

Methods

To assess the potential effects of the ‘Angelina Jolie’ effect, referral data specific to breast cancer family history was obtained from around the UK for the years 2012 and 2013. A consortium of over 30 breast cancer family history clinics that have contributed to two research studies on early breast surveillance were asked to participate as well as 10 genetics centres. Monthly referrals to each service were collated and increases from 2012 to 2013 assessed.

Results

Data from 12 family history clinics and 9 regional genetics services showed a rise in referrals from May 2013 onwards. Referrals were nearly 2.5 fold in June and July 2013 from 1,981 (2012) to 4,847 (2013) and remained at around two-fold to October 2013. Demand for BRCA1/2 testing almost doubled and there were also many more enquiries for risk reducing mastectomy. Internal review shows that there was no increase in inappropriate referrals.

Conclusions

The Angelina Jolie effect has been long lasting and global, and appears to have increased referrals to centres appropriately.     

基于AD7707芯片的数据采集系统设计

1 系统实现 1.1 系统框图低频信号进入AD转换通道,转换后的数据通过DSP的SPI接口传送到DSP,随后存储在扩展存储器内,以便后续的信号分析处理. DSP的SPI接口完成数据接受和发送等任务. 电源和时钟模块分别为AD芯片和DSP提供电源和独立的时钟信号.