The burden of cutaneous disease in solid organ transplant recipients of color

Organ transplant recipients (OTRs) are at increased risk of cutaneous malignancy. Skin disorders in OTRs of color (OTRoC) have rarely been systematically assessed. We aimed to ascertain the burden of skin disease encountered in OTRoC by prospectively collecting data from OTRs attending 2 posttransplant skin surveillance clinics: 1 in London, UK and 1 in Philadelphia, USA. Retrospective review of all dermatological diagnoses was performed. Data from 1766 OTRs were analyzed: 1024 (58%) white, 376 (21%) black, 261 (15%) Asian, 57 (3%) Middle Eastern/Mediterranean (ME/M), and 48 (2.7%) Hispanic; and 1128 (64%) male. Viral infections affected 45.1% of OTRs, and were more common in white and ME/M patients (P < .001). Fungal infections affected 28.1% and were more common in ME/M patients (P < .001). Inflammatory skin disease affected 24.5%, and was most common in black patients (P < .001). In addition, 26.4% of patients developed skin cancer. There was an increased risk of skin cancer in white vs nonwhite OTRs (HR 4.4, 95% CI 3.5-5.7, P < .001): keratinocyte cancers were more common in white OTRs (P < .001) and Kaposi sarcoma was more common in black OTRs (P < .001). These data support the need for programs that promote targeted dermatology surveillance for all OTRs, regardless of race/ethnicity or country of origin.     

Functional transition: Inconsistently parallel to the increase in future liver remnant volume after preoperative portal vein embolization

BACKGROUNDPreoperative portal vein embolization (PVE) is a widely used strategy to enable major hepatectomy in patients with insufficient liver remnant. PVE induces hypertrophy of the future liver remnant (FLR) and a shift of the functional reserve to the FLR. However, whether the increase of the FLR volume (FLRV) corresponds to the functional transition after PVE remains unclear.AIMTo investigate the sequential relationship between the increase in FLRV and functional transition after preoperative PVE using 3-dimensional (3D) computed tomography (CT) and ^99mTc-galactosyl-human serum albumin (^99mTc-GSA) single-photon emission computed tomography (SPECT) fusion images. METHODSThirty-three patients who underwent major hepatectomy following PVE at the Department of Gastroenterological Surgery I, Hokkaido University Hospital between October 2013 and March 2018 were enrolled. Three-phase dynamic multidetector CT and ^99mTc-GSA SPECT scintigraphy were performed at pre-PVE, and at 1 and 2 wk after PVE; 3D ^99mTc-GSA SPECT CT-fused images were constructed from the Digital Imaging and Communications in Medicine data using 3D image analysis system. Functional FLRV (FFLRV) was defined as the total liver volume × (FLR volume counts/total liver volume counts) on the 3D ^99mTc-GSA SPECT CT-fused images. The calculated FFLRV was compared with FLRV.RESULTSFFLRV increased by a significantly larger extent than FLRV at 1 and 2 wk after PVE (P < 0.01). The increase in FFLRV and FLRV was 55.1% ± 41.6% and 26.7% ± 17.8% (P < 0.001), respectively, at 1 wk after PVE, and 64.2% ± 33.3% and 36.8% ± 18.9% (P < 0.001), respectively, at 2 wk after PVE. In 3 of the 33 patients, FFLRV levels decreased below FLRV at 2 wk. One of the three patients showed rapidly progressive fatty changes in FLR. The biopsy at 4 wk after PVE showed macro- and micro-vesicular steatosis of more than 40%, which improved to 10%. Radical resection was performed at 13 wk after PVE. The patient recovered uneventfully without any symptoms of pos-toperative liver failure.CONCLUSIONThe functional transition lagged behind the increase in FLRV after PVE in some cases. Evaluating both volume and function is needed to determine the optimal timing of hepatectomy after PVE.     

基于政策工具的我国三医联动政策量化分析

目的:对我国发布的27份三医联动政策文件的政策工具进行分析,探究我国三医联动政策体系的着重点与缺失点,为健全我国三医联动政策体系提供参考。方法;以我国2014—2019年发布的27份三医联动政策文件为研究对象,以政策工具为视角对纳入分析的政策文件进行摘录和编码,采用内容分析法和定量分析法对各项政策工具进行统计分析,并确定其运用情况。结果:260个政策编号中,需求型,供给型和环境型政策工具分别占6.9%、24.6%和68.5%;医疗、医保和医药政策工具分别占54.2%、24.6%和21.2%。由此可以看出,我国三医联动改革对环境现状的依赖程度较大,需求与供给政策相对不足,而医疗则是三医联动改革的核心关键点。结论:应适当增加需求型和供给型政策工具,着重解决医疗方面的重难点问题,促使医疗、医保、医药三个利益主体达成合力,形成“三医既联又动”的协同发展机制。     

Does the washout phenomenon of Tc-99m HM-PAO correlate to the “Filling-in” phenomenon of I-123 IMP with brain SPECT?

Summary Using SPECT, the time course of brain uptake was compared between N-isopropyl-p-[I-123]-iodoamphetamine (I-123 IMP) and Tc-99m d,l hexamethyl-propyleneamine oxime (Tc-99m HM-PAO). Of 14 patients with cerebrovascular disease showing areas of the filling-in phenomenon (i.e. delayed uptake) with I-123 IMP brain SPECT, 7 exhibited persistent defects with Tc-99m HM-PAO (Group I), and 7 showed early washout after the initial uptake (Group II). The filling-in of I-123 IMP did not always correlate to the washout region of Tc-99m HM-PAO. The temporal changes were also confirmed by semiquantitative analysis. While the filling-in of I-123 IMP was affected by many factors, the washout of Tc-99m HM-PAO was attributed to significant reduction of Tc-99m HM-PAO in the plasma. Delayed imaging of the brain with Tc-99m HM-PAO using SPECT may give a more accurate estimate of regional cerebral blood flow in cerebrovascular disease, because it should be lees effected by cerebral blood volume.     

Detection of traumatic myocardial injury by means of simultaneous T1-201/Tc-99m pyrophosphate tomography--report of three cases

Trauma to the chest can result in cardiac damage, which maybe missed by clinical examination because of associated injuries.Routinely performed non-invasive tests may also be non-diagnostic.Tc-99m pyrophos-phate (PPi) tomography, in this study combinedwith T1-201, is a promising addition to non-invasive evaluation.In three patients with cardiac injury, this technique successfullydetected and localized myocardial necrosis.     

Atrial natriuretic factor and autonomic nervous system function in man

Summary To delineate a possible interaction of atrial natriuretic peptide ANF-(99–126) with autonomic nervous system function in humans, a spectrum of indices were assessed in 10 healthy young men during a 90 min iv administration of a) synthetic ANF-(99–126) 50 g bolus followed by 0.025 g·kg^–1·min^–1, b) the potent vasodilator sodium nitroprusside (SNP) 0.35 g·kg^–1·min^–1, or c) vehicle 0.9% NaCl 40 ml and 20% albumin 5 ml, in random sequence.Plasma immunoreactive ANF (irANF) rose from 32 to 1700 pg·ml^–1 during the ANF-(99–126) infusion and was stable during SNP or vehicle. Infusion of ANF-(99–126) and SNP, but not vehicle, decreased diastolic blood pressure (BP) on average by –9 and –7.5%, respectively; systolic BP was largely unchanged. Heart rate (HR, +15 and 12%) or plasma norepinephrine (NE) rose similarly during ANF-(99–126) and SNP infusions, and the systolic BP response to orthostasis was similar (–18 mm Hg). The following autonomic indices did not differ significantly after the 3 infusions: responses of HR and NE to orthrostasis; reflex bradycardic response to phenylephrine (PE)-induced rise in systolic BP (+20 mm Hg); responses of BP to hyperventilation, PE, or 3 min of sustained handgrip; and beat-to-beat variation (R-R interval) during deep breathing. The immediate orthostatic HR response (30/15 R-R interval ratio) fell similarly during infusion of ANF-(99–126) or nitroprusside.The findings indicate that in healthy men the function of the autonomic nervous system is not notably impaired by high circulating ANF levels. ANF-(99–126) infused in moderate dosage seems to lower BP largely by non-autonomic mechanisms.The study was supported in part by the Swiss National Science Foundation     

口服莫沙必利治疗功能性消化不良的随机对照试验

目的　观察新型促胃肠动力药莫沙必利 (胃 5 HT4受体促进剂 )对功能性消化不良 (FD)的随机对照试验。方法　FD患者 42例 ,随机分为试验组 (2 1例 ,服枸橼酸莫沙必利片 )和对照组 (2 1例 ,服吗叮啉片 )。采用GCP标准 ,双盲法观察 ,在实验开始前、服药第 1 4、2 8天记录症状变化及副作用发生情况。随机抽取部分患者于实验开始前和结束时做99MTc胃排空试验。结果　莫沙必利对FD症状的疗效与吗叮啉组相当 (P >0 .0 5 )。99MTc胃排空测定发现莫沙必利组治疗后的半排时间 (45 .0 5± 1 2 .2 1 )min缩短 ,1 2 0min残留率 (2 9.73%± 8.5 1 % )减少 (P <0 .0 5 ) ,两组病例未发现毒副反应。结论　莫沙必利对于FD疗效良好 ,对胃排空延迟有良好疗效 ,安全度高。     

99m锝标记紫杉醇脂质体在移植荷瘤鼠体内分布的研究

对 2 0只雌性裸鼠建立人卵巢癌裸鼠皮下移植瘤模型 ,经其尾静脉注射锝标紫杉醇脂质体 (99m TC- TL) 0 .2m l,于 15 min、 30 m in、 90 m in各处死动物 5只 ,将心、肝、脾、肺、肾、小肠、子宫附件、骨及肿瘤组织分别称重。其余 5只动物尾静脉注射游离锝 (99m TC— F) 0 .2 m l,于 90 min处死 ,取肝、脾、肺及肿瘤组织称重 ,用 γ-定标仪测其放射强度 (单位 :CPM/ 10 0 mg)。肝、脾、肺脏器内 99m TC动态放射值最高 (5 5 2 .1± 92 .8～ 2 6 0 .1± 2 1.0 cpm/ 10 0m g) ,其放射强度随时间延长呈下降趋势 ,肿瘤组织放射值较低 (3.6± 0 .6 cpm/ 10 0 m g) ,动态测量呈水平位。99m TC- TL组与 99m TC- F组在 99m TC示踪显示 90 min时 ,TC- TL 组肝、脾、肺内放射强度高于 99m TC- F组 (P<0 .0 5 ) ,而肿瘤组织中两组无显著性差异 (P>0 .0 5 )。结论 :静注紫杉醇脂质体在荷瘤鼠体内主要定向分布于网状内皮系统丰富的肝、脾、肺器官内 ,肿瘤组织有一定滞留性 ,但亲和力较差