THE PITUITARY-LEYDIG CELL AXIS IN MEN WITH SEVERE DAMAGE TO THE GERMINAL EPITHELIUM

Eighteen men (mean age 27, range 18-30 years) treated for Hodgkin's disease with 6-8 courses of MVPP (Mustine, Vinblastine, Procarbazine and Prednisolone) have had Leydig cell function assessed by their steroidogenic responses to stimulation by a single bolus dose of HCG (1000 units intramuscularly). Normal age-matched men (n = 16) acted as controls. Baseline immunoreactive FSH was markedly raised in the patients (mean 18.1 +/- SD 6.9 vs 2.0 +/- 1.5 IU/l, P less than 0.0001) reflecting damage to the germinal epithelium. Immunoreactive LH was also greater in patients (10.3 +/- 3.9 IU/l) than in controls (3.9 +/- 1.9 IU/l, P less than 0.0001). There were no differences between the baseline testosterone, androstenedione, oestradiol, oestrone and sex hormone binding globulin (SHBG) concentrations. The testosterone/SHBG ratios were similar in the two groups and there was no correlation between baseline LH and testosterone concentrations or testosterone/SHBG ratios. Testosterone, androstenedione, oestradiol and oestrone secretion in response to HCG stimulation were similar at 24 h and 96 h in both groups. In order to explain the paradox of elevated immunoreactive LH in the face of normal testicular steroidogenesis in such patients, LH biological activity (B) as well as LH immunoreactivity (I) and FSH and testosterone were estimated in a second similar group of patients (n = 17, mean age 27, range 17-43 years) and in a further age-matched control group (n = 17). Bioactive and immunoreactive LH levels were significantly increased (P less than 0.005 and P less than 0.001, respectively) in the patient group.(ABSTRACT TRUNCATED AT 250 WORDS)     

Membrane flow within the myelin sheath in IDPN neuropathy

This report describes some aspects of beta,beta'-iminodipropionitrile (IDPN) neuropathy in rats as observed by ultrastructural methods and X-ray diffraction. Light microscopy shows gross swelling of the axons in proximal lumbar spinal roots 8 days after intraperitoneal injection of IDPN. Mean axon cross-sectional area and mean axon perimeter increased to 280% and 160% of their control values, respectively. At the same time, myelin membrane packing was not visibly disturbed. In addition, X-ray diffraction patterns, recorded under physiological conditions, demonstrate that the myelin lipid bilayer thickness and widths of the aqueous spaces between bilayers did not change. Related observations are made on posterior tibial nerve (PNS myelin) and ventral spinal cord (CNS myelin). The various observations together are interpreted in terms of a fluid myelin membrane. It is proposed that the myelin membrane flows during axon swelling even though normal membrane-membrane contacts are maintained within the sheath. Membrane flow and slippage between membranes are explained in terms of a molecular model of the myelin multilayer.     

Computation of Time-Constant Histograms from the Forced Expired Volume-Time Curves

An efficient BASIC program was established on Apple-Ⅱmicrocomputer with the CHESTAC-35F pulmonary function testing system tocalculate the time-constant histogram from the spirogram.By a set of analogousstudies,we confirmed that the recovered time-constant histogram was within onecompartment of the assumed one and that the root of mean square values of theresiduals between the experimental and model volume-time curves was 0.02.Infour healthy adult subjects,the mean value of time-constant histograms(TCx)hadthe variation coefficient 6.6％.The results show that our method is reliable andreproducible,and it can be used for clinical investigation.     

双黄连粉针剂加蒙脱石治疗婴幼儿秋季腹泻的疗效观察

目的: 观察双黄连粉针剂加蒙脱石口服治疗婴幼儿秋季腹泻的疗效.方法: 双黄连粉针剂加蒙脱石口服治疗102例秋季腹泻患儿,并与单用蒙脱石或双黄连组相比较.结果: 治疗组总有效率达92.1%,病程明显缩短(4.52±0.56)d;而单用蒙脱石或双黄连组有效率分别为67.4%,60.2%;病程分别为(5.90±0.72)d,(6.15±0.92)d,联合用药组与单用蒙脱石或双黄连组相比较,总有效率及病程均有显著性差异(P＜0.01).结论: 双黄连加蒙脱石治疗婴幼儿秋季腹泻疗效好,可提高治愈率,缩短病程,是较为安全而有效的药物.     

Outcome of children with respiratory symptoms without objective evidence of asthma: a two-year, prospective, follow-up study

This study evaluated the outcome of 33 children with asthma-like symptoms without objective evidence of asthma, and the role of certain factors in predicting the development of clinical asthma in these children. Data on symptom histories, lung functions (flow-volume spirometry, free running test and methacholine inhalation challenge test) and atopic sensitization (skin prick tests and markers of eosinophilic inflammation) were collected twice with an interval of 2 y, and the diagnoses were re-evaluated after the follow-up period. Based on the results, it was concluded that one-third of the children with prolonged or recurrent lower airway symptoms, such as cough or wheeze, either have mild asthma or will develop asthma in the near future. Children who had a significant response [≥ 10% fall in forced expiratory volume in 1 s (FEV1)] in the free running test formed a risk group for active asthma, whereas other baseline characteristics seemed not to predict the outcome.     

Randomized trial examining cerebral haemodynamics following artificial or animal surfactant

To determine the effects of animal and artificial surfactants on cerebral haemodynamics, 20 premature babies receiving mechanical ventilation were randomized to receive Curosurf or Exosurf surfactant. Anterior cerebral artery blood flow velocity (CABFV) was measured using Doppler ultrasound before and up to 2 h after treatment. Following animal surfactant there was a rapid reduction in CABFV (median -36%, range -43% to +8%, p < 0:01), whereas artificial surfactant resulted in a slower rise which was less marked (median +20%, range -7% to +62%, p < 0:05). There were no significant changes in blood pressure. Two hours after administration, the oxygenation index (OI) improved significantly only in babies receiving animal surfactant. In this group there was a significant association between the change in CABFV at 1 min and the change in OI at 2 h ( r = 0:66, p < 0:05). Animal surfactant produces rapid improvements in ventilation which are associated with marked alterations in cerebral haemodynamics.     

地塞米松对脓毒血症鼠Peyer小结Tfh细胞的影响

目的：测定脓毒血症鼠Peyer小结内滤泡辅助性T细胞（T follicular helper,Tfh）的变化,分析地塞米松（dexamethasone,Dex）对脓毒血症Tfh细胞的可能作用。方法：昆明小鼠诱导脓毒血症模型,模型诱导成功后随机分2组,脓毒血症组（SE组,n=12）、脓毒血症＋Dex处理组（DE组,n=12）。另设对照组（NC组,n=12）。测定血清白介素-6（interleukin-6,IL-6）、降钙素原（procalcitonin,PCT）、中性粒细胞明胶酶相关载脂蛋白（neutrophil gelatinase-associated lipocalin,NGAL）水平。Peyer小结Ⅰ型1-磷酸鞘氨醇（Sphingosine 1-Phosphate 1,S1P1）、CXC趋化因子配体13（CXC chemokine ligand 13,CXCL13）免疫组化染色。Western blot分别检测Peyer小结IL-21、程序性死亡分子-1（programmed death 1,PD-1）、胞嘧啶脱氨酶（enzyme activation-induced cytidine deaminase,AID）蛋白的表达。流式细胞仪测定3组Peyer小结Tfh细胞占T淋巴细胞的百分率。结果：与NC组相比,SE组血清IL-6（19.7±5.20 vs 10.7±3.60 ng·L~（-1））、PCT（1.56±0.92 vs 0.31±0.09μg·L~（-1））、NGAL（0.44±0.11 vs 0.35±0.09 mg·L（-1））升高（P〈0.05或0.01）,Peyer小结S1P1（0.22±0.06 vs 0.14±0.04）、CXCL13（0.25±0.07 vs 0.15±0.04）的表达增加（P〈0.01）,IL-21（0.60±0.08 vs 0.35±0.08）、PD-1（0.30±0.04 vs 0.20±0.05）、AID（0.23±0.05 vs 0.18±0.03）蛋白的表达亦升高（P〈0.05或0.01）,Tfh细胞占T淋巴细胞（8.30±2.00 vs 5.69 vs 1.64%）的百分率升高（P〈0.01）。Dex治疗可降低SE鼠血清IL-6（19.7±5.20 vs 12.8±3.40 ng·L~（-1））、PCT（1.56±0.92 vs 0.71±0.44μg·L~（-1））水平（P〈0.05或0.01）,降低Peyer小结S1P1（0.22±0.06 vs 0.17±0.05）、CXCL13（0.25±0.07 vs 0.19±0.06）的表达（P〈0.05或0.01）,下调Peyer小结IL-21（0.60±0.08 vs 0.48±0.09）、PD-1（0.30±0.04 vs 0.26±0.06）、AID（0.23±0.05 vs0.19±0.04）蛋白的表达（P〈0.05）,降低Tfh细胞占T淋巴细胞（8.30±2.00 vs 6.56±1.59%）的百分率（P〈0.05）。结论：Peyer小结Tfh细胞可能参与脓毒血症的发病机制,Dex抑制Peyer小结Tfh的活化,对Peyer小结微环境起保护作用。     

Atrioesophageal Fistula After Cryoballoon Pulmonary Vein Isolation

Atrioesophageal Fistula After Cryoballoon PV Isolation . The risk of atrioesophageal fistula after cryoballoon pulmonary vein isolation is thought to be much lower than after radiofrequency ablation, seeing that no data exist on this complication so far. We report for the first time on the occurrence of an atrioesophageal fistula 4 weeks after cryoballoon ablation at the site of the left inferior pulmonary vein. We suggest that even when using cryothermal ablation technique, an imaging modality to assess the proximity of esophagus and left atrium should be routinely performed to avoid this fatal complication. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1254–1257, November 2012)     

Female Gender and Diabetes Mellitus Increase the Risk of Recurrence after Laparoscopic Incisional Hernia Repair

Background

Laparoscopic hernia repair is used widely for the repair of incisional hernias. Few case studies have focussed on purely ‘incisional’ hernias. This multicentre series represents a collaborative effort and employed statistical analyses to provide insight into the factors predisposing to recurrence of incisional hernia after laparoscopic repair. A specific hypothesis (ie, laterality of hernias as well as proximity to the xyphoid process and pubic symphysis predisposes to recurrence) was also tested.

Methods

This was a retrospective study of all laparoscopic incisional hernias undertaken in six centres from 1 January 2004 to 31 December 2010. It comprised a comprehensive review of case notes and a follow-up using a structured telephone questionnaire. Patient demographics, previous medical/surgical history, surgical procedure, postoperative recovery, and perceived effect on quality of life were recorded. Repairs undertaken for primary ventral hernias were excluded. A logistic regression analysis was then fitted with recurrence as the primary outcome.

Results

A total of 186 cases (91 females) were identified. Median follow-up was 42 months. Telephone interviews were answered by 115/186 (62%) of subjects. Logistic regression analyses suggested that only female sex (odds ratio (OR) 3.53; 95% confidence interval (CI) 1.39–8.97) and diabetes mellitus (3.54; 1–12.56) significantly increased the risk of recurrence. Position of the defect had no statistical effect.

Conclusions

These data suggest an increased risk of recurrence after laparoscopic incisional hernia repair in females and subjects with diabetes mellitus. These data will help inform surgeons and patients when considering laparoscopic management of incisional hernias. We recommend a centrally hosted, prospectively maintained national/international database to carry out additional research.