Local synthesis of IgA in the cerebrospinal fluid of patients with neurological diseases

To date qualitative studies of IgA in the cerebrospinal fluid in neurological disease, particularly multiple sclerosis, have been few and given mixed results. The aim of this study was to identify local synthesis of IgA by detection of clonal IgA bands, in a large cohort of patients with a variety of neurological disorders, using polyacrylamide gel electrophoresis, transfer of protein to nitrocellulose membranes and specific staining. Of 2,097 sequentially analysed patients with suspected neurological disease 54 (2.6%) had locally synthesised IgA; most notably, IgA was present in 39 of 291 (13%) patients with suspected multiple sclerosis. The latter group also had a significant excess of light-chain production, particularly free kappa, when compared to multiple sclerosis patients without local synthesis of IgA. Locally synthesised IgA was also demonstrated in inflammatory, infectious and autoimmune diseases of the central nervous system. This qualitative technique is simple and suitable for routine analysis of cerebrospinal fluid, and further qualitative studies of IgA may be useful in investigating the pathophysiology of certain neurological disorders.     

流动人口对产科质量因素的影响

目的分析流动人口和本地人口对产科质量的影响,寻找危害孕产妇安全的主要因素。方法对我院2003年9月至2005年6月产科流动人口和本地人口的病例资料进行回顾性分析。结果我院本地人口孕产妇产检率为841．87‰,明显高于流动人口的210．78‰(P＜0．05)。流动人口孕产妇胎儿宫内窘迫、早产、过期妊娠、产后出血、胎：盘早剥、新生儿窒息、低出生体重儿的发生率均明显高于本地人口(P值均＜0．05)。结论继续提高流动人口高危孕产妇检出率、管理好流动人口孕产妇将是提高上海市产科质量工作的新重点。     

壁式氧气管道装置消毒方法的研究

目的解决壁式氧气管道装置的污染和消毒问题,特别是对其不可拆卸部位的消毒. 方法通过细菌学的实验检测,在了解其污染状况的基础上,针对壁式氧气管道装置的结构特点,采用 0.2%过氧乙酸(PAA) 局部浸泡加吹氧的消毒方法. 结果消毒后瓶盖及送氧管出口、通气导管内、外壁等全部部件无细菌生长. 结论必须高度重视壁式氧气管道装置的消毒工作.     

Local anesthetic systemic toxicity (LAST) – Should we not be concerned?

Local anesthetics are one of the most commonly used drugs in the field of medicine. Yet little is known about the systemic toxicity that can occur with their overdose. In the last few years, a lot of research has taken place understanding the etiology of the Local anesthetics systemic toxicity (LAST) and the role of lipid emulsion in treating it. There is a need to increase the awareness about LAST and establish a protocol to treat any serious neuro or cardiotoxicity.     

In vivo perivascular implantation of encapsulated packaging cells for prolonged retroviral gene transfer

Long-term benefits of coronary angioplasty remain limited by the treatmentinduced renarrowing of arteries, termed restenosis. One of the mechanisms leading to restenosis is the proliferation of smooth muscle cells. Therefore, proliferating cells of the injured arterial wall, which can be selectively transduced by retroviruses, are potential targets for gene therapy strategies. A direct single-dose therapeutic application of retroviral vectors for inhibition of cell proliferation is normally limited by too low transduction efficiencies. Encapsulated retrovirus-producing cells release viral vectors from microcapsules, and may enhance the transduction efficiency by prolonged infection. Primary and immortal murine and porcine cells and murine retrovirusproducing cells were encapsulated in cellulose sulphate. Cell viability was monitored by analysing cell metabolism. Safety, stability, transfer efficiency and extent of restenosis using capsules were determined in a porcine restenosis model for local gene therapy using morphometry, histology, in situ betagalactosidase assay and PCR. Encapsulation of cells did not impair cell viability. Capsules containing retrovirus-producing cells expressing the beta-galactosidase reporter gene were implanted into periarterial tissue or a pig model of restenosis. Three weeks following implantation, beta-galactosidase activity was detected in the pericapsular tissue with a transduction efficiency of ~ 1 in 500 cells. Adventitial implantation of vector-producing encapsulated cells for gene therapy may, therefore, facilitate successful targeting of proliferating vascular smooth muscle cells, and allow stable integration of therapeutic genes into surrounding cells. The encapsulation of vector-producing cells could represent a novel and feasible way to optimize local retroviral gene therapy.     

Infiltration of Bupivacaine Local Anesthetic to Trocar Insertion Sites After Laparoscopy: A Randomized,Double-blind,Stratified, and Controlled Trial

Study ObjectiveTo determine if injection of local anesthetic into trocar insertion sites after laparoscopy improves postoperative pain.DesignA prospective, 2-arm, randomized, double-blind, stratified, and controlled trial (Canadian Task Force classification I).SettingA university-based teaching hospital.PatientsThis study was performed on women who had a laparoscopic gynecologic procedure for benign indications from March 2013 to June 2013. One hundred thirty-five subjects were stratified by chronic pelvic pain or no chronic pelvic pain. Chronic pelvic pain was defined as pelvic pain occurring for 6 months or more in duration. Randomization was performed for this trial, with 68 receiving a bupivacaine block and 67 receiving no bupivacaine block. Of the 71 patients with chronic pelvic pain, 35 patients were in group 1 (i.e., bupivacaine block) and 36 patients were in group 2 (i.e., no bupivacaine block).InterventionsAfter the laparoscopic surgery was completed, the trocar incision sites were closed. For subjects randomized to receive a local anesthesia block, bupivacaine (0.25%) was injected. Incisions 8 mm or greater were injected with 10 mL 0.25% bupivacaine. Incisions 5 mm or less were infiltrated with 5 mL. Injecting the local anesthetic through all preperitoneal layers provided a full-thickness local injection. Group 2 did not receive a local injection.Measurements and Main ResultsAt the preoperative suite, the nurses gauged the patient's pain using the Numeric Rating Scale. This score was used as the baseline pain level with which the postoperative pain scores were compared. The primary objective was to measure changes in pain scores, from preoperative to postoperative time frames of 2 to 4 hours, 6 to 8 hours, 18 to 24 hours, and 3 to 7 days postoperatively. These score changes were measured as the main objective. Secondary objectives include estimated blood loss, operating time, length of hospital stay, and histopathologic diagnosis. The hospital personnel caring for the patient during the preoperative and postoperative course were given standard pain evaluation protocols. All study pain evaluators and patients were blinded to treatment assignments throughout the pain assessment process. There were no statistically significant differences in patient characteristics between the 2 treatment groups. No significant difference was found in secondary outcomes including estimated blood loss, length of hospital stay, and histopathologic diagnosis. In general, Numeric Rating Scale pain scores were lower (i.e., less pain) in the “bupivacaine block” group compared with the “no bupivacaine” block group at the following postsurgery time assessments: 2 to 4 hours, 6 to 8 hours, 18 to 24 hours, and 3 to 7 days after surgery. However, the effect was not large enough (<1 point) to show a statistical difference between the treatment groups at any of these postsurgery assessments.ConclusionThe postoperative injection of bupivacaine in trocar port sites did not significantly improve pain scores after laparoscopic gynecologic surgery.     

Experiencia y tratamiento anestésico en el implante transcatéter de la prótesis valvular aórtica autoexpandible CoreValve®

ObjectiveTo analyze the experience and anesthetic management in the transcatheter implantation of the CoreValve^® self-expanding aortic valve, in a university tertiary hospital.Material and methodsObservational analytical review of data incorporated into a prospectively maintained database of 142 patients diagnosed with severe aortic stenosis who underwent implantation of a CoreValve^® aortic self-expanding aortic valve between December 2007 and December 2012.ResultsThe mean age of patients was 82.5 ± 6.1 years and the logistic EuroSCORE was 14.9 ± 11.2. General anesthesia was used in 107 patients (75.3%), with local anesthesia with sedation in 35 (24.6%). Local anesthesia and sedation was associated with a lower requirement of vasoactive drugs (P = .003) during implantation. No statistically significant differences were found between the 2 anesthetic techniques in the duration of the procedure, hospital stay, or morbimortality. The success rate was 97.1%. The most common complication was conduction disorders that required implantation of a permanent pacemaker in 46 patients (32.3%). There was no intraoperative mortality, and all-cause mortality at 30 days was 6.3%, with a one-year survival estimated by the Kaplan-Meier of 83.1%.ConclusionsThis study confirms that in patients with severe aortic stenosis and high surgical risk, transcatheter implantation of aortic valve is a safe and effective alternative. Both, general anesthesia and local anesthesia with sedation are valid options, depending on the experience of the team.     

A patient who changed my practice: The case for patient-based evidence versus trial-based evidence

A patient who has an unequivocal psychotic illness within the schizoaffective spectrum is described. Over the course of the past 10 years she has convinced me that her way of looking at her own illness, particularly her refusal to take medication, has merits that cannot be dismissed as the overwrought workings of a disturbed mind. Her experience has helped me to understand that it is still possible to be an advocate of evidence-based medicine and yet accommodate the wishes of patients in a way that sometimes elevates personal patient-based evidence above that of external criteria. ( Int J Psych Clin Pract 2000; 4: 253 - 255)     

氟尿嘧啶植入剂在原发性晚期上皮性卵巢癌术中的应用效果

目的 探讨氟尿嘧啶植入剂在原发性晚期上皮性卵巢癌（PAEOC）肿瘤细胞减灭术中的临床疗效。方法 回顾性分析安徽医科大学第一附属医院2007年6月至2012年12月收治并成功随访的162例PAEOC患者的临床资料，根据手术关腹前是否植入缓释氟脲嘧啶植入剂将患者分为试验组（术中腹腔植入缓释氟尿嘧啶600 mg）80例和对照组（术中未植入氟尿嘧啶植入剂）82例。观察两组患者的化疗副反应、术后并发症及生存率。结果 术后两组化疗副反应差异无统计学意义（P>0.05）；试验组与对照组近期生存率差异无统计学意义（χ²=2.865，P=0.091），而生存率的远期效应，试验组高于对照组，差异有统计学意义（χ²=4.911，P=0.027）。结论 术中植入氟尿嘧啶植入剂是一种安全、有效的腹腔局部化疗方法，可提高患者的远期生存率。