Hypotensive brain stem necrosis in a stillborn

Summary Hypotensive brain stem necrosis is reported in a stillborn. Additional postmortem findings included evidence of intrauterine distress, shock, and a pure blood culture of group B -hemolytic streptococci. These findings suggest group B -hemolytic streptococcal sepsis in utero, with a subsequent episode of transitory circulatory failure prior to intrauterine demise.     

Association of Opioid Use Disorder With 2016 Presidential Voting Patterns: Cross-sectional Study in New York State at Census Tract Level

BackgroundOpioid overdose-related deaths have increased dramatically in recent years. Combating the opioid epidemic requires better understanding of the epidemiology of opioid poisoning (OP) and opioid use disorder (OUD).ObjectiveWe aimed to discover geospatial patterns in nonmedical opioid use and its correlations with demographic features related to despair and economic hardship, most notably the US presidential voting patterns in 2016 at census tract level in New York State.MethodsThis cross-sectional analysis used data from New York Statewide Planning and Research Cooperative System claims data and the presidential voting results of 2016 in New York State from the Harvard Election Data Archive. We included 63,958 patients who had at least one OUD diagnosis between 2010 and 2016 and 36,004 patients with at least one OP diagnosis between 2012 and 2016. Geospatial mappings were created to compare areas of New York in OUD rates and presidential voting patterns. A multiple regression model examines the extent that certain factors explain OUD rate variation.ResultsSeveral areas shared similar patterns of OUD rates and Republican vote: census tracts in western New York, central New York, and Suffolk County. The correlation between OUD rates and the Republican vote was .38 (P<.001). The regression model with census tract level of demographic and socioeconomic factors explains 30% of the variance in OUD rates, with disability and Republican vote as the most significant predictors.ConclusionsAt the census tract level, OUD rates were positively correlated with Republican support in the 2016 presidential election, disability, unemployment, and unmarried status. Socioeconomic and demographic despair-related features explain a large portion of the association between the Republican vote and OUD. Together, these findings underscore the importance of socioeconomic interventions in combating the opioid epidemic.     

以特色学科为纽带组建集团医院

介绍了复旦大学附属华山医院与多年来合作伙伴、多家企业医院协商,在双方自愿的前提下,组建以神经外科为主,神经内外科、放射科紧密合作,以神经外科作为主要治疗手段的集团医院的具体做法。指出,组建集团医院不仅是数量的发展,更主要的是质量的提高。必须注重内涵建设,注重可持续发展的后劲。与此同时,必须转变观念,正确处理好相关学科之间的关系。     

Minority Race and Ethnicity is Associated With Higher Complication Rates After Revision Surgery for Failed Total Hip and Knee Joint Arthroplasty

BackgroundRacial and ethnic disparities in access to hip and knee total joint arthroplasty (TJA) and postoperative outcomes have wide-reaching implications for patients and the health care system. The aim of this study is to evaluate the effect of ethnicity on clinical outcomes and complications following revision hip and knee TJA.MethodsA single-institution, retrospective analysis of a consecutive series of 4424 revision hip and knee TJA patients was evaluated. Student’s t-test and chi-squared analysis were used to identify significant differences in patient demographics and clinical outcomes between Caucasians and various ethnic minorities, including African Americans, Hispanics, and Asians.ResultsWhen compared with white patients, African American patients demonstrated a significantly higher BMI (P = .04), ASA score (P = .04), length of hospital stay (P = .06), and postoperative infection rates (P = .04). Hispanics demonstrated a significantly higher BMI (P = .04), when compared with white patients, alongside a significantly higher risk for postoperative infection (P < .01). African American demonstrated a significantly higher ASA score (P = .02; P = .03), when compared with Hispanics and Asians, alongside a significantly increased length of stay (P = .01) and higher risk for postoperative infection (P = .02).ConclusionThe study findings demonstrate an underutilization of revision TJA by ethnic minority groups, suggesting that disparities in access to orthopedic surgery increase from primary to revision surgery despite higher failure rates of minority ethnic groups reported after primary TJA surgery. In addition, inferior postoperative outcomes were associated with African Americans and Hispanics, when compared to white patients, with African Americans demonstrating the highest risk of postoperative complications.     

Racism,stress and health in Asian Americans: A structural equation analysis of mediation and social support group differences

The buffering effect of social support on the negative effects of racism exposure on health outcomes has been mixed in prior studies regarding Asian Americans. Based on the stress-coping framework and using structural equation modelling (SEM) methods, we tested a theoretical model portraying simultaneous mediational paths from racism exposure to general physical and mental health through racism-related stress. Bootstrap analysis was used to test the indirect effects present in the model. Additionally, multi-group SEM analysis was conducted to investigate the moderation effect of social support from family and friends on the paths in the model. The sample consisted of 310 Asian American adults who completed an online survey. The results from the two-step SEM analysis and bootstrap analysis supported the theoretical model—racism exposure can simultaneously have a negative indirect effect on Asian Americans' physical and mental health via racism-related stress. Multi-group SEM analysis showed that there were no differences in model path coefficients based on having varying levels of social support from friends or family.     

煤的热解研究III.煤中官能团与热解生成物

借助化学分析和ＦＴＩＲ光谱分析对我国煤化程度不同的１８ 种煤中官能团的研究表明：煤中官能团含量与煤化程度有关;煤中羧基、羟基及醚键等其他含氧官能团的含量与热解生成物ＣＯ２、Ｈ２Ｏ 和ＣＯ 的产率有关,脂肪—ＣＨ 的含量与甲烷和焦油的产率相关联,芳香—ＣＨ 的含量与热解半焦产率有关。煤的热解生成物主要是煤中官能团的断裂所致。     

Prevalence and clinical relevance of Blastocystis hominis in diverse patient cohorts

The pathogenicity of Blastocystis hominis is extensively debated in the medical literature. Therefore, we did a prevalence study to investigate the association between the presence of several intestinal parasites and gastrointestinal symptoms in diverse patient cohorts. The study population consisted of 1216 adults, including immunocompromised patients, institutionalized psychiatric or elder subjects, immigrants from developing countries, travellers to developing tropical countries and controls. Several variables for each risk group were considered. Stools specimens, collected in triplicate, were processed by the same technicians. Clinical data about each subject were provided by standardized questionnaires. The presence of gastrointestinal symptoms were related to the presence of any parasite. In addition, on the basis of microbiological results, five subgroups of subjects were evaluated. The results showed a high prevalence of parasites in all the risk groups. Immunocompromised status, recent arrival from developing countries and the presence of behavioural aberrations were significantly related to presence of parasites. B. hominis was the parasite most frequently detected in each studied group. B. hominis showed a significant correlation with gastrointestinal symptoms only when detected in the group including subjects with a severe immunodepression. Immunodepression seems to be a factor of primary importance of the pathogenic role of B. hominis.     

Blutgruppenantigenexpression in papillären karzinomen der schilddrüse Eine immunhistochemische und klinische studie über das Vorkommen von Lewis-, AB0- und verwandten antigenen

Zusammenfassung In einer immunhistochemischen Arbeit wurden 104 papilläre Schilddrüsenkarzinome auf das Vorkommen von Blutgruppenantigenen des AB0- und Lewis-Systems sowie verwandter, tumorassoziierter Antigene mit Typ-1- und Typ-2-Grundstruktur untersucht. Folgende Strukturen wurden im Gewebe nachgewiesen: CA-50 (sialinierter Typ-1-Vorläufer), CA-19-9 (Sialyl-Le^a), Le^a, Le^b, A, B, H, Le^x, Sialyl-Le^x und Le^y. Während gesundes, adultes Schilddrüsengewebe keine Blutgruppenantigene exprimierte, waren die papillären Karzinome durch die progressive Expression dieser Strukturen gekennzeichnet. Die meisten Tumoren reagierten mit dem C-50-Antikörper (84%), während deutlich weniger Gewebe das CA-19-9-Antigen aufwiesen (38%). Die Typ-2-Strukturen Le^x (47%) und Le^y (13%) wurden deutlich seltener gefunden als die korrespondierenden Typ-1-Antigene Le^a (71%) und Le^b (62%). Die Vorbehandlung mit Neuraminidase verstärkte die Le^a- und Le^x-Färbeergebnisse in 27 bzw. 44 Fällen. Von den A-, B-, und H-Antigenen wurden die A-Determinanten am häufigsten nachgewiesen (24%). In vergleichenden Untersuchungen von Serienschnitten der gleichen Tumoren wurde eine Koexpression mehrerer Typ-1-Antigene im denselben Tumorarealen festgestellt. Karzinome mit Expression von Typ-1- und Typ-2-Strukturen wiesen häufig eine komplementäre Antigenexpression in verschiedenen Bereichen der Gewebe auf. Einige Tumoren exprimierten Typ-1- und Typ-2-Strukturen auch in den gleichen Zellen, jedoch in verschiedenen Bereichen der jeweiligen Zellen.In 68 Fällen wurde eine Follow-up-Untersuchung durchgeführt. Die Beobachtungszeiträume lagen zwischen 12 und 217 Monaten. In 13 Fällen rezidivierte der Tumor, 7 dieser Patienten verstarben an dem Tumorleiden. Die meisten Rezidive traten bei Patienten auf, deren Tumoren die Grenzen des Organs überschritten hatten (pT4, n=19), während keines der pT1-Karzinome (n=20) zu einem Rezidiv geführt hatte. Während Lymphknotenmetastasen in 39 Fällen auftraten, wiesen 6 Patienten Fernmetastasen auf. Die klinischen Ergebnisse wurden mit den Färbeergebnissen korreliert. Es bestand kein Zusammenhang zwischen Antigenexpression und Tumordifferenzierung. Die pT4-Tumoren zeigten eine signifikant stärkere Expression der CA-50-, CA-19-9-, Le^a und Sialyl-Le^x-Strukturen. Karzinome mit Le^y-Expression wiesen signifikant häufiger Metastasen auf. Le^y, H-Typ-1 und H-Typ-2 traten häufiger in rezidivierenden Tumoren auf. Im Gegensatz dazu waren alle Patienten, deren Karzinom das A-Antigen exprimierte, fernmetastasen- und rezidivfrei (n=14). In der multiplen Regressionsanalyse wies der Faktor Fernmetastasierung die größte prognostische Relevanz auf, während im Vergleich dazu die Färbeergebnisse statistisch von untergeordneter Bedeutung waren.

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Blood group antigen expression in papillary carcinoma of the thyroid — An immunohistochemical and clinical study on the occurrence of Lewis-, AB0, and derived antigens

Nine monoclonal antibodies, lectin from Ulex europaeus and neuraminidase enzyme were employed to demonstrate the occurrence of type 1 and type 2 blood group antigens in 104 cases of papillary carcinoma of the thyroid. The reagents applied, recognize the following blood group related antigens: CA-50 (sialylated type 1 precursor), CA-19-9 (sialylated Le^a), Le^a, Le^b, A, B, H, Le^x, sialylated Le^x, and Le^y.Immunohistochemical studies revealed that papillary carcinoma of the thyroid, in contrast to histologically normal thyroid tissue, is characterised by a progressive expression of blood group antigens. Most tumours (84%) reacted with C-50 antibody, whereas only a minority of the tissues demonstrated the CA-19-9 antigen (38%). Type 2 structures Le^x (47%) and Le^y (13%) were found less often than their corresponding type 1 isomers Le^a (71%) and Le^b (62%). Desialylation with neuraminidase increased the Le^a and Le^x staining intensity in 27 and 44 cases, respectively. of the A, B, H antigens the A determinants encountered most frequently (24%).Comparative examinations of sequential sections of the same tumour revealed coexpression of type 1 antigens in the same areas. In carcinomas showing type 1 and type 2 antigen reactivity, a complementary distribution of the structures in different tumour areas was often demonstrated. Some tumours presented combined type 1 and type 2 antigen expression in the same cells, however, in distinct areas within the cell.A follow-up examination was carried out in 68 of the 104 cases. The observation time ranged from 12 to 217 months. Thirteen patients suffered from recurrence, of which 7 died. While lymphatic metastases occurred in 39 tumours, distant metastases were detected in 6 patients. Most of the recurrences were found in patients with tumour classification pT4 (n=19), whereas none of the pT1 carcinomas (n=20) showed recurrence.The clinical results were compared to the blood group antigen expression results. There was no correlation between antigen expression and differentiation degree of the tumour. The pT4 tumours showed a significant higher expression of the CA-50, CA-19-9, Le^a and Sialyl Le^x structures. Carcinomas expressing the Le^y antigen were associated with a significant higher level of metastasizing capacity. The Le^y, H type 1 and H type 2 antigens occurred more frequently in recurrent tumours (n=14). In contrast, none of the patients whose carcinomas expressed the Aantigens (n=14) suffered from a recurrence or hematogenous metastasis.Multiple stepwise regression analysis was carried out to check the importance of each staining and clinical factor. In this analysis, distant metastasis was the most important parameter, whereas the staining results were of minor statistical importance.

     

Psychoeducational groups to teach children sexual abuse prevention skills

A series of studies on sexual abuse prevention are presented to highlight important clinical and research issues. In a multi-modal evaluation conducted by the author, elementary children who participated in three group sessions using the Feeling Yes, Feeling No prevention program increased significantly in knowledge and the ability to discriminate unsafe from safe situations. Gains were maintained over a one-year follow-up period. Approximately 5% of the children disclosed sexually abusive experiences. Participating children also exhibited no more anxiety or behavior problems after the program than control children. A second study evaluated the relative efficacy of prevention programs for children conducted by teachers vs. expert consultants. Children in each trainer condition demonstrated equivalent knowledge gains and made equivalent numbers of disclosures. Clinical research by other authors is reviewed to highlight important issues in prevention groups with preschoolers and adolescents, the impact of prevention education on feelings about sexuality, and behavioral effects of prevention programs. Finally, the incorporation of prevention education into psychotherapeutic groups for child victims is discussed.     

Experimental vaccinia virus meningoencephalitis in adult albino mice: Virological,light microscopic and ultrastructural studies

Summary Adult NMRI mice were inoculated intracerebrally with 1.5–5×10² pfu of the neurovirulent strain Ma1 of vaccinia virus. The animals usually became diseased on day 3 and died on day 5 or 6 p.i. Infectivity assay studies on the mouse brains yielded a steeply rising viral titer comparable with that exhibited by several other so-called neurovaccinia strains after intracerebral inoculation. Histological studies revealed a patchy leptomeningitis most apparent over the basal brain surface. Mononuclear elements of varied size were the most common infiltrate cells in the meningitic lesions. These often showed a pronounced hemorrhagic and necrotizing character. In some places, the cellular infiltrates within the subarachnoid space extended along the perforating vessels into the superficial cerebral cortex. By electron microscopy, all essential stages of virus morphogenesis including the discharge of mature virions could be seen in numerous mononuclear phagocytes and adventitial cells. In contrast to this, no unequivocal neuroectodermal cell showed morphologic evidence of productive viral infection. Likewise, no endothelia or vascular myocytes were encountered which contained newly formed virus particles. However, alterations of the walls of blood vessels and signs of disturbed vascular permeability were a frequent finding in the meningeal foci of inflammation as well as in and around the track left by the inoculating needle. Another ultrastructural feature of the meningitic lesions was the widespread occurrence of degenerating or disintegrating infiltrate cells both infected and uninfected ones.The virologic and morphologic findings observed in this model of experimental vaccinia virus meningo-encephalitis are discussed with regard to data previously published by other authors. The propensity of strain Ma1 of vaccinia virus (and most probably of other so-called neurovaccinia strains) for replication in mesenchymal cells in particularly emphasized.