Autoantibodies to Human Tissue Transglutaminase: Superior Predictors of Coeliac Disease

Background: Using selected sample populations, we compared sensitivity and specificity of autoantibodies to guinea pig and human tissue transglutaminase to assess if the human antigen is superior for predicting coeliac disease. Methods: Four commercial enzyme-linked immunoassay kits using human tissue transglutaminase as antigen were used to measure autoantibody levels in serum samples from untreated adult coeliacs ( n = 32). They were from a series of 130 cases diagnosed between 1997 and 1999 and chosen to bias the group towards subjects with negative autoantibodies when measured with guinea pig tissue transglutaminase as antigen. Samples from 38 control subjects (biased towards false-positive levels with guinea pig antigen) were used to compare specificity. We also assessed if human antigen kits could differentiate between levels in normal subjects and in selective IgA deficiency. Results: Sensitivity for coeliac disease in this selected group using the human antigen kits ranged from 88% to 100%. Three kits showed significantly higher specificity (82%-97%, P < 0.05) than the guinea pig antigen kit (71%) for the samples studied. No kit achieved complete separation between normal autoantibody levels and lower levels in selective IgA deficiency. Conclusions: All human antigen kits showed significantly higher sensitivity for coeliac disease compared to guinea pig antigen ( P < 0.001). Receiver operating characteristic curves confirmed the superior diagnostic accuracy of the human antigen kits.     

The effects of pulp and paper mill effluent on physiological and hematological endpoints in fingerling largemouth bass (Micropterus salmoides)

The purpose of this study was to evaluate the effects of bleached kraft mill effluent on selected physiological and hematological endpoints in fingerling largemouth bass (Micropterus salmoides). Fish were exposed for 35 days to surface water collected at sites up- and downstream from a pulp and paper mill treatment-effluent discharge. The condition factor, spleen somatic index, and pronephros cellularity were statistically significantly decreased in fish exposed to the downstream site, compared to the upstream site. There was also a shift from lymphocytes to neutrophils in peripheral blood of fish exposed to the downstream site. Hematocrit values and the liver somatic index were statistically significantly increased in fish in the downstream exposure. These results indicate that in-stream exposure to elemental-chlorine-free pulp and paper mill effluents produce a generalized stress response, leading to potential immunosuppression in fish.     

骨不连治疗的研究与技术应用进展*

背景：骨不连是骨折晚期常见的临床问题,数十年来,在各种新式内外固定材料、普及的显微外科技术、创新的植骨材料,尤其是分子生物学技术的全面帮助下,骨不连的治疗取得了突破性进展。
　　目的：总结骨不连治疗的研究进展,为以后更好地治疗骨不连提供技术理论和方法选择。
　　方法：由第一作者运用计算机检索系统检索1990年1月至2013年5月发表的有关骨不连原因及治疗方法的文献,以“fracture nonunion,treatment,progress”或“骨不连,治疗方法,进展”为检索词。同一领域则选择近期发表或者发表在权威杂志的文章。
　　结果与结论：排除重复性研究及时间跨度大的文献,从检索结果中共选择了48篇文章进一步分析。骨不连治疗手段主要有两种：非手术方式和手术方式,目前临床上以手术方式为主且高效。骨折愈合是多环节参与的复杂过程,一旦骨不连发生,应具体问题具体分析,根据患者的实际情况采取个体化治疗原则,重视软组织的保护,必要时联合运用多种手术及非手术方法,才能取得满意的疗效。     

组织多普勒超声评价急性肺动脉栓塞患者右室功能的研究

目的　探讨应用组织多普勒成像 (TDI)评价急性肺动脉栓塞 (PE)患者右室功能的价值。方法　应用TDI观察13例应用螺旋CT诊断的急性PE患者治疗前后右室功能参数的改变 ,并分析TDI参数与肺动脉栓塞指数之间的关系。结果　急性PE患者治疗后右室侧壁基底段VE较治疗前显著增高 ( 10 .2 7± 3 .83 )cm/svs ( 13 .48± 3 .82 )cm/s ,P <0 .0 5 ,VA显著降低 ( 2 3 .16± 6.89)cm/svs ( 17.88± 3 .79)cm/s ,P <0 .0 5 ,右室侧壁各节段VE/VA增高显著 ;右室侧壁基底段VE/VA与螺旋CT肺动脉阻塞指数之间显著相关 (r =-0 .45 9,P <0 .0 5 )。结论　TDI参数对急性PE患者病变程度及疗效判定有一定的临床应用价值。     

Matrix depletion of young and old human articular cartilage by cultured autologous synovium fragments: a chondrocyte-independent effect

Summary Human articular cartilage of different ages was cultured for 8 days and proteoglycan (PG) release into the medium was measured. Retinol and synovial co-culture increased the PG release of cartilage of all ages. The effect of retinol was dose-dependent. Synovium increased also the PG release of dead cartilage, whereas retinol did not. The increased PG release by synovial co-culture is therefore mainly the result of synovial enzymes acting directly on the matrix rather than of a factor inducing chondrocyte-mediated breakdown.     

Hematopoietic reconstitution after bone marrow transplantation: Assessment with MR imaging and H-1 localized spectroscopy

Magnetic resonance (MR) studies were performed in 14 patients as early as possible (21–110 days) after bone marrow transplantation (BMT). MR characteristics of lumbar vertebral bone marrow were studied with T1-weighted spin-echo imaging, water- and fatselective imaging with a frequency-selective excitation technique, and point-resolved spatially localized proton spectroscopy. Signals from water and fat protons and their T1 and T2 values were analyzed. Water proton signal intensity correlated well with cellularity within bone marrow, as determined with parallel iliac crest biopsies. The fraction of signal from water in red bone marrow of patients with allogeneic transplants from siblings (four cases) was significantly higher than in four patients with autologous transplants. The latter showed very low cellularity in the period of about 4 weeks after BMT because of the cytotoxic pretreatment of the bone marrow. The MR results in six patients with allogeneic transplants from unrelated donors ranged widely, depending on the complications after BMT. Analysis of data obtained with the different techniques showed that water- and fat-selective MR imaging and spectroscopic methods are useful for noninvasive monitoring of hematopoietic reconstitution after BMT.     

Time after excision and temperature alter ex vivo tissue relaxation time measurements

Previously unreported effects of tissue storage were recently observed in the authors' experimental magnetic resonance (MR) studies. To evaluate the effect of elapsed time after excision and storage temperature on tissue relaxation time measurements, tissue samples from the liver, pancreas, kidney, testis, spleen, and brain were obtained in rats. T1 and T2 were first measured within 5 minutes of excision, and between subsequent measurements, tubes were kept in a water bath at 40°C, at room temperature (28°C), or in an ice bath (4°C). Cellular and organellar integrity was assessed with electron microscopy and correlated with the MR findings. At 40°C (20-MHz spectrometer), the T1 of liver decreased from 280 msec ± 8 to 212 msec ± 10 during the first 60 minutes; the T1 of pancreas decreased from 276 msec ± 3 to 208 msec ± 2. Other tissues showed less than a 5% decrease in T1. T2 changes were smaller than T1 changes in all tissues. Electron microscopy of pancreatic acinar cells showed postmortem changes in mitochondria evolving over the first 60 minutes after death. Manganese loading experiments implicated mitochondrial manganese stores in the observed enhanced postmortem decrease in T1. This study calls into question reported relaxation time data for liver and pancreas. MR studies of excised tissues must account for time and temperature to prevent systematic experimental errors.     

Precise and accurate measurement of proton T1 in human brain in vivo: Validation and preliminary clinical application

Precise and accurate inversion-recovery (PAIR) magnetic resonance (MR) measurements of T1 were obtained in eight brain regions and cerebrospinal fluid of 26 healthy volunteers. Accuracy of the technique was assessed by measuring T1 in small fluid volumes with the PAIR technique and with two independent spectroscopic techniques. The mean difference between T1 measured with PAIR and with the two spectroscopic techniques was 3.1% ± 1.3. The precision (reproducibility) of measurements with the PAIR technique was excellent. The coefficient of variation (CV) across 16 measurements in a head phantom was 2.0%, compared with a CV of 2.7% across 45 separate measurements in a single subject. The within-subject CV was 1.8% ± 0.6 in white matter and 1.4% ± 1.0 in basal ganglia. The between-subject CV in 26 healthy volunteers was 3.6% ± 0.6 in white matter and 4.1% ± 1.9 in basal ganglia. Comparison between a patient with an active recurrent brain tumor and an agematched patient with an inactive brain tumor showed that T1 was significantly elevated throughout the brain of the active-tumor patient, especially in white matter tracts, even though no tumor or edema was detected in the white matter on standard MR images. Comparisons between five brain tumor patients and four healthy volunteers of similar age showed that T1 was significantly and substantially elevated throughout the white matter tracts and in the caudate nucleus, putamen, and thalamus. These results are consistent with the hypothesis that white matter tracts are selectively vulnerable to edema and that T1 increases in white matter are a sensitive indicator of patient status or tumor aggressiveness.     

Cultured composite autografts as coverage for an extensive body surface area burn: case report and review of the technology

Cultured epithelial autografts (CEA) have been used as an adjunct in the surgical management of extensive thermal burns. Unfortunately, the lack of a dermal matrix makes CEA susceptible to infection, shearing forces and limits their incorporation into the burn wound. A cultured composite autograft (CCA) has been developed in which autologous keratinocytes and fibroblasts are surgically harvested from the burn patient's normal skin. These components are proliferated and then combined to form an epidermal and dermal matrix, grown to confluence then applied.

Standard wound coverage techniques as well as CCA technology were utilized for successful wound closure in a 12 yr-old female with an 81% third degree burn. After fascial excision and allograft coverage, autografts were placed on her posterior burns and then 7500 cm² of CCA was placed onto her anterior thorax, abdomen and lower extremities. Sixty percent of the burn was covered with CCA resulting in a success rate of 40%. No evidence of infection was noted, even in areas where CCA failed, although in those areas random epithelialization appeared to occur which then seemed to facilitate autograft placement. Early debridement and allografting followed by conventional autografts and CCA placement may provide an effective skin coverage strategy in patients with extensive deep burns.     

急诊游离趾甲皮瓣修复或重建拇指

目的探讨急诊应用游离趾甲皮瓣修复或重建拇指的最佳适应证。方法对１２例拇指脱套伤和４例无再植条件的拇指离断伤,彻底清创后,采用游离趾甲皮瓣修复或重建拇指。术中发现,第一跖骨背动脉均系ＧｉｌｂｅｒｔⅢ型,选择足背动脉为动脉蒂,大隐静脉为静脉蒂。结果１６例重建拇指全部成活。创面Ⅰ期愈合１５例,１例末节皮缘局部坏死,经换药后愈合。术后随访６个月～１２年,重建拇指的感觉和运动功能恢复良好。结论不能再植的拇指缺失或拇指皮肤脱套伤,是急诊应用游离趾甲皮瓣移植的最佳适应证。