Tension-free vaginal tape for the treatment of urodynamic stress incontinence with intrinsic sphincteric deficiency

The purpose of this study was to evaluate the outcome of tension-free vaginal tape (TVT) procedure in women with urodynamic stress incontinence diagnosed as having intrinsic sphincteric deficiency (ISD). The combination of a maximal urethral closure pressure <20 cm H₂O and a Valsalva leak point pressure <60 cm H₂O was considered as diagnostic of ISD. Subjects with detrusor overactivity on preoperative urodynamics were excluded. A total of 35 patients with both low closure pressure and leak point pressure were enrolled. Bladder perforation occurred in three (8.6%) cases. Postoperative urinary voiding difficulties occurred in nine (25.7%) women. Two patients underwent surgical detension of the tape, with complete resolution of urinary retention and no relapse of incontinence. Women with postoperative voiding dysfunction had a significantly lower detrusorial pressure at the peak flow on preoperative urodynamics compared to those who voided efficiently after TVT. The mean (range) follow-up time was 12.5 months (3–36). The objective cure rate for stress incontinence was 91.4%. Two of the three (66%) patients in whom the TVT procedure failed had a fixed urethra. De novo urge incontinence was found in five (14.3%) patients.     

薄块MIP在听小骨显示中的作用评价

目的探讨通过多层螺旋CT各向同性扫描进行薄块最大密度投影(th in slab m aximum intensity projection,ts-M IP)后处理对听小骨的显示能力。方法对35例患者行多层螺旋CT各向同性扫描,然后在工作站进行ts-M IP后处理,观察横断面、冠状面和矢状面ts-M IP对听小骨的显示情况。结果横断面、冠状面和矢状面ts-M IP均能对锤骨、砧骨及锤砧关节进行显示,其中横断面ts-M IP显示砧镫关节较好,并可同时显示锤骨柄及砧骨长脚的全长;冠状面ts-M IP可显示锤骨的全貌;矢状面ts-M IP显示听小骨可很好地避免各结构地重叠。结论通过多层螺旋CT各向同性扫描获得的图像进行ts-M IP后处理,能够很好地显示正常锤骨、砧骨及砧镫关节,其缺点是对镫骨的显示欠佳。     

Post-operative esophageal leak treated with removable silicone-covered polyester stent

Self-expanding removable covered stents are increasingly being used for the treatment of benign esophageal diseases such as leaks or perforations and stenosis. They are easy to place and remove and good outcomes have been reported. We report a case of a postoperative esophageal leak successfully managed with a removable silicone-covered polyester stent.     

食管癌颈部吻合术中前壁单层吻合术的应用

目的　探讨食管癌颈部吻合术中前壁单层吻合的临床应用价值 ,并与同期荷包状食管胃吻合法 (前壁双层吻合法 )相比较。方法　对 32 1例食管癌行根治性切除及食管胃颈部吻合术 ,其中前壁双层吻合 16 1例 ,前壁单层吻合16 0例。结果　双层吻合术中 ,吻合口瘘 5例 (3.13% ) ,随访 137例 ,吻合口直径 <0 .5 cm者占 5例 (3.5 % ) ,0 .5 - 1cm者70例 (5 0 .9% ) ,1cm以上者 6 2例 (4 5 .6 % ) ,单层吻合术中 ,吻合口瘘 7例 (4 .38% ) ,随访 131例 ,吻合口直径 <0 .5 cm者无 1例发生 ,0 .5 - 1cm者 5 3例 (4 0 .8% ) ,>1cm以上者 78例 (5 9.2 % )。结论　食管癌颈部吻合术中 ,前壁单层吻合能减少吻合口狭窄 ,改善术后病人的生活质量 ,而吻合口瘘发生率无明显增加。     

A monoclonal antibody (RH1-38) which inhibits multiple systems of cell-mediated cytotoxicity--II. Evidence that the epitope recognized is involved in a late step in the cytolytic mechanism

A monoclonal antibody (RH1-38) which blocks multiple systems of cell-mediated cytotoxicity was functionally characterized. RH1-38 specifically blocks, in the absence of complement, natural killer (NK) activity (K562 targets) without any effect on NK-K562 conjugate formation. Kinetic studies suggested that the antibody blocks a step that occurs 30-120 min after effector populations are mixed with target cells. Single-cell cytotoxicity assays in agarose, combined with standard 51Cr release assays and Michaelis-Menten analysis revealed that RH1-38 markedly decreases Vmax and the number of active NK cells, again without any effect on the number of target-binding cells. The maximum recycling capacity was usually decreased, but in some experiments unchanged, in the presence of the monoclonal antibody. RH1-38 inhibited equally well whole peripheral blood mononuclear leukocytes (PBML), Percoll-fractionated lymphocytes enriched for NK activity, and interferon (IFN)-boosted NK activity. PBML exposed to RH1-38 and then washed mediated depressed NK activity which was partially reversed by subsequent treatment with IFN. These studies are most consistent with the hypothesis that RH1-38 inhibits a step late in the NK cytolytic mechanism rather than through an effect on conjugate formation. The primary effect is probably not on the IFN-generating or boosting mechanism, but a secondary effect on IFN-related mechanisms cannot be ruled out. Inhibition through an effect on a small lymphocyte modulator of NK activity is also unlikely but not rigorously excluded. Thus, RH1-38 appears to inhibit NK activity through a direct effect on NK effector cells, probably by interfering with a cell-surface molecule which is important in the expression of NK activity. The companion paper demonstrates that this monoclonal antibody immunoprecipitates a molecule which is very similar or identical to the LFA-1 antigen. Thus, RH1-38 recognizes either a novel epitope on the LFA-1 molecule or alternatively a distinct, functional killer cell surface molecule. The epitope appears to be involved in a late step in the cytolytic mechanism, possibly part of the effector cell lytic machinery.     

Does Low FEV1 in Addition to Fixed Ratio and/or Lower Limit of Normal of FEV1/FVC Improve Prediction of Mortality in COPD? The NHANES-III-linked-mortality Cohort

Purpose

There is presently an ongoing debate on the relative merits of suggested criteria for spirometric airway obstruction. This study tests the null hypothesis that no superiority exists with the use of fixed ratio (FR) of forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) < 0.7 versus less than lower limit predicted (LLN) criteria with or without FEV1 <80% predicted in regards to future mortality.

Characterization of a monoclonal anti-Bw4 antibody (Tü109): Evidence for similar epitopes on the Bw4 and Bw6 antigens

The production and serologic, as well as immunochemical properties of a cytotoxic murine IgG monoclonal antibody (Tü109) that precipitates HLA-class I molecules, are described. In the microcytotoxicity assay Tü109 supernatant was demonstrated on a panel of 424 HLA-ABC, -DR, -DQ, -MT typed normal Caucasian blood donors to define an epitope on HLA-B locus molecules in great association with the supertypic specificity Bw4. Reactivity of supernatant showed MHC linked inheritance of the Tü109 determinant and discriminated the HLA-Bw4/Bw6 associated HLA-B locus split antigens. Weak or lack of binding on lymphocytes from some HLA-Bw4 heterozygous individuals, particularly typing for HLA-Bw44, appeared to be due to qualitative and/or quantitative variations of HLA-B locus molecules on the cell surface. With Tü109 ascites fluid, however, extra-reactivity on all HLA-Bw6⁺ cells was demonstrated. Preferential binding of supernatant to HLA-Bw4, but reactivity of ascites fluid with HLA-Bw6⁺ molecules in addition, was furthermore confirmed by IEF analysis of antigens immunoprecipitated with Tü109 from cell lysates. Thus the antibody may help to analyze the evolutionary relationship of the diallelic specificities Bw4 and Bw6.     

Setting out the frame conditions for feasible use of FFPE derived RNA

Introduction

The usage of formalin-fixed paraffin embedded (FFPE) tissue is characterized by its long shelf-life and simple handling. Therefore it is the most commonly available tissue specimen in routine diagnostics and histological studies. Formaldehyde fixation may result in RNA degradation and cross linking with proteins, while storage conditions also affect RNA integrity. The present study was designed to investigate the influence of these factors on RNA analysis.

Heritabilities,by the multiple abstract variance analysis (MAVA) model and objective test measures,of personality traits U.I.23, capacity to mobilize,U.I.24, anxiety,U.I.26, narcistic ego and U.I.28, asthenia,by maximum-likelihood methods

Heritability coefficients are offered for four personality source traits, measured by the O-A (objective-analytic) 2-h performance battery. Five family constellations covering a total sample of 1221 boys 12–18 years old yielded nine concrete variances which the MAVA (multiple abstract variance analysis) model resolves into seven abstract variances: ² _wg , within family genetic; ² _wt.s , within family threptic; ² _wt.t , within family threptic for twins; ² _bg , between family genetic; _bgbt , correlation of genetic and threptic deviations across families, etc. Maximum likelihood was the method here used for the MAVA analysis. The best fit with maximum parsimony was to assume no genothreptic ( _wgwt , _bgbt ) correlations, but extension to the parsimony of assuming either no genetic or no threptic components gave no fit. The heritabilities found were compared with those from an earlier research and from a different (OSES) method applied to the present data. The agreement is quite good in assigning a moderate heritability value tocapacity to mobilize vs. regression, U.I.23 (H about 0.30), and toanxiety, U.I.24 (H about 0.50); only moderately consistent in assigning a moderateH value toasthenia, U.I.28 (H about 0.30); and poorly consistent in assigning a lowH value tonarcistic ego, U.I.26. It is pointed out (a) that the lowH for U.I.28 fits the theory of the origin of this trait well and (b) that, in view of estimates of the function fluctuation of U.I.23 and 24, a most probable conclusion is that a capacity to mobilize is quitesubstantially innate and a general proneness to anxiety islargely innate.     

Electrical properties of metallic electrodes

The series equivalent resistance R and capacitance C of metal/saline electrode/electrolyte interfaces were measured as a function of frequency (100 Hz–20k Hz) and current density (0·25 to 1000 A m⁻²) for eight typical electrode metals. For each of the metals tested, R decreased and C increased as the current density was increased above a critical value (with the exception of silver and MP35N at frequencies above 1 kHz for which R increased and C decreased slightly). With the exception of copper, the current density linearity limit (for 10 per cent decrease in R or 10 per cent increase in C) increased with increasing frequency and, in most cases, the current density linearity limit for 10 per cent increase in C was slightly less than that for 10 per cent decrease in R. Among the metals tested, copper and aluminium had the lowest current carrying capability and rhodium had the highest current-carrying capability. The current carrying capabilities of 316 SS, platinum, silver and MP35N, were intermediate and similar. With increasing current density, an increase in the electrode/electrolyte capacitance was the most sensitive indicator of the current-carrying linearity limit.