BACKGROUND & AIMS: :Bedside duplex/color Doppler sonography is used for a wide gamut of abnormalities encountered in the neonatal intensive care unit. This article emphasizes the use of bedside sonography for evaluation of infants with necrotizing enterocolitis, infants requiring line placement, and those in whom a diaphragmatic abnormality is suspected. Although the assessment of those infants requires excellent operator skills, learning to do so is a definite benefit to these babies who would otherwise be exposed to ionizing radiation.

背景与目标： : 床边双工/彩色多普勒超声检查用于新生儿重症监护病房中遇到的各种异常情况。本文强调使用床旁超声检查评估坏死性小肠结肠炎婴儿，需要行放置的婴儿以及怀疑diaphragm肌异常的婴儿。尽管对这些婴儿的评估需要出色的操作员技能，但学习这样做对这些原本会受到电离辐射的婴儿来说是绝对的好处。

BACKGROUND & AIMS: :Propidium monoazide (PMA) or ethidium bromide monoazide (EMA) treatment has been used before nucleic acid detection methods, such as PCR, to distinguish between live and dead cells using membrane integrity as viability criterion. The performance of these DNA intercalating dyes was compared in many studies utilizing different microorganisms. These studies demonstrated that EMA and PMA differ in their abilities to identify nonviable cells from mixed cell populations, depending on the microorganism and the nature of the sample. Due to this heterogeneity, both dyes were used in the present study to specifically distinguish dead from live Candida albicans cells using viable quantitative PCR (qPCR). The viable qPCR was optimized, and the best results were obtained when pre-treating the cells for 10 min in the dark with 25 μM EMA followed by continuous photoactivation for 15 min. The suitability of this technique to distinguish clotrimazole- and fluconazole-treated C. albicans cells from untreated cells was then assessed. Furthermore, the antifungal properties of two commercial essential oils (Thymus vulgaris and Matricaria chamomilla) were evaluated. The viable qPCR method was determined to be a feasible technique for assessing the viability of C. albicans after drug treatment and may help to provide a rapid diagnostic and susceptibility testing method for fungal infections, especially for patients treated with antifungal therapies.

背景与目标： : 在核酸检测方法 (例如PCR) 之前，已使用单叠氮化丙啶 (PMA) 或溴化乙锭单叠氮化物 (EMA) 处理，以膜完整性作为生存标准来区分活细胞和死细胞。在许多利用不同微生物的研究中比较了这些DNA嵌入染料的性能。这些研究表明，根据微生物和样品的性质，EMA和PMA在从混合细胞群体中识别非存活细胞的能力上有所不同。由于这种异质性，在本研究中使用了两种染料，以使用可行的定量PCR (qPCR) 特异性区分死亡的白色念珠菌细胞。优化了可行的qPCR，并在黑暗中用25μm EMA预处理细胞10分钟，然后连续光活化15分钟，可获得最佳结果。然后评估了该技术区分克霉唑和氟康唑处理的白色念珠菌细胞与未处理细胞的适用性。此外，还评估了两种商业精油 (百里香和洋甘菊) 的抗真菌特性。可行的qPCR方法被确定为评估药物治疗后白色念珠菌生存能力的可行技术，并可能有助于提供一种快速诊断和药敏试验方法，特别是对于接受抗真菌治疗的患者。

BACKGROUND & AIMS: PURPOSE:To demonstrate the utility of a new concept of intraoperative use of high frequency ultrasound (hfioUS) in maximizing the extent of resection (EOR) of intracerebral high-grade tumors. MATERIALS AND METHODS:22 Patients harboring an intracerebral high-grade tumor were retrospectively included in this study (14 primary tumors, 8 metastasis). 14 of them had a perilesional edema equal or greater to lesion volume, 3 had previously received radiotherapy. Following macroscopic tumor debulking, the small (11 × 31 mm) L15 - 7io (Philips, Bothell, USA) high-frequency probe (7 - 15 MHz) was introduced into the resection cavity and its walls were meticulously scanned to search for tumor remnants. Postoperative MR scan was evaluated by a board-certified independent neuroradiologist, who assessed the EOR. RESULTS:Gross total resection was achieved in 21 patients (95.5 %). One patient had a small tumor remnant (6 × 4 × 3 mm) of a very large (80 × 60 × 74 mm) anaplastic astrocytoma, detected in the postoperative MR scan. A permanent postoperative hemiparesis was diagnosed in one patient with a metastasis in the motor area, while the other patients recovered without permanent neurological deficits from the surgery. CONCLUSION:The hfioUS probe allowed in this study a precise detection of the tumor and a detailed discrimination between normal, pathological and edematous tissue in all 22 cases. :ZIEL:: Darstellung eines neuen intraoperativen Konzepts basierend auf Hochfrequenz-Ultraschall (hfioUS) zur Maximierung der Resektion hochgradiger intrazerebraler Tumoren. MATERIAL UND METHODEN:22 Patienten mit hochgradigen intrazerebralen Tumoren (14 primäre Tumoren, 8 Metastasen) wurden retrospektive in diese Studie eingeschlossen. 14 dieser Patienten zeigten ein perifokales Ödem gleich oder größer als das Läsionsvolumen, 3 Patienten erhielten präoperativ bereits Radiotherapie. Nach der makroskopischen Tumorentfernung wurde die hfioUS-Messsonde L15 – 7io (Philips, Bothell, USA) mit einer Größe von 11 × 31 mm in die Tumorhöhle eingeführt und die Wände dieser nach Tumorresten untersucht. Postoperative MRTs wurden von einem unabhängigen Neuroradiologen bezüglich Resektionsgrad ausgewertet. ERGEBNISSE:Eine makroskopische Totalresektion wurde bei 21 Patienten (95.5 %) erreicht. Ein Patient mit einem großen anaplastischen Astrozytom (80 × 60 × 74 mm) zeigte einen kleinen Resttumor (6 × 4 × 3 mm) im postoperativen MRT. Eine permanente postoperative Hemiparese zeigte sich bei einem Patient mit einer Metastase im motorischen Areal, die restlichen Patienten erholten sich postoperative ohne permanentes neurologisches Defizit von der Operation. SCHLUSSFOLGERUNG:In dieser Studie erlaubte die hfioUS-Messsonde bei allen 22 Fällen eine präzise Darstellung des Tumors und eine detaillierte Unterscheidung zwischen regelrechtem, pathologischem und ödematösem Hirnparenchym.

背景与目标：

BACKGROUND & AIMS: :The objective of this study was to evaluate the effects of ultrasound-mediated analyte diffusion on permeability of normal, benign, and cancerous human lung tissue in vitro and to find more effective sonophoretic (SP) delivery in combination with the optical clearing agents (OCAs) method to distinguish normal and diseased lung tissues. The permeability coefficients of SP in combination with OCAs diffusion in lung tissue were measured with Fourier-domain optical coherence tomography (FD-OCT). 30% glucose and SP with a frequency of 1 MHz and an intensity of 0.80  W/cm2 over a 3 cm probe was simultaneously applied for 15 min. Experimental results show that the mean permeability coefficients of 30% glucose/SP were found to be (2.01±0.21)×10(-5)  cm/s from normal lung (NL) tissue, (2.75±0.28)×10(-5)  cm/s from lung benign granulomatosis (LBG) tissue, (4.53±0.49)×10(-5)  cm/s from lung adenocarcinoma tumor (LAT) tissue, and (5.81±0.62)×10(-5)  cm/s from lung squamous cell carcinoma (LSCC) tissue, respectively. The permeability coefficients of 30% glucose/SP increase approximately 36.8%, 125.4%, and 189.1% for the LBG, LAT, and LSCC tissue compared with that for the NL tissue, respectively. There were statistically significant differences in permeability coefficients of 30% glucose/SP between LBG and NL tissue (p<0.05), between LAT and NL tissue (p<0.05), and between LSCC and NL tissue (p<0.05). The results suggest that the OCT functional imaging technique to combine an ultrasound-OCAs combination method could become a powerful tool in early diagnosis and monitoring of changed microstructure of pathologic human lung tissue.

背景与目标： : 这项研究的目的是评估超声介导的分析物扩散对体外正常，良性和癌性人肺组织通透性的影响，并找到与光学清除剂 (OCAs) 结合更有效的超声电泳 (SP) 递送方法，以区分正常和患病的肺组织。用傅里叶域光学相干断层扫描 (fd-oct) 测量SP与OCAs扩散在肺组织中的渗透系数。在3厘米探针上同时施加频率为1 MHz且强度为0.80   W w/cm2的30% 葡萄糖和SP 15分钟。实验结果表明，30% 葡萄糖/SP对正常肺 (NL) 组织的平均渗透系数为 (2.01 ± 0.21)× 10(-5)  cm cm/s，肺良性肉芽肿 (LBG) 组织 (2.75 ± 0.28)× 10(-5)  cm/s，肺腺癌肿瘤 (LAT) 组织 (4.53 ± 0.49)× 10(-5)  cm/s，和 (5.81 ± 0.62)× 10(-5)  cm cm/s分别来自肺鳞状细胞癌 (LSCC) 组织。与NL组织相比，LBG、LAT和LSCC组织的30% 葡萄糖/SP的渗透系数分别增加约36.8% 、125.4% 和189.1%。LBG与NL组织之间 (p<0.05)，LAT与NL组织之间 (p<0.05) 以及LSCC与NL组织之间 (p<0.05) 的30% 葡萄糖/SP的渗透系数差异有统计学意义。结果表明，OCT功能成像技术结合超声-OCAs组合方法可以成为早期诊断和监测病理性人肺组织微观结构变化的有力工具。

BACKGROUND & AIMS: :We carried out the first meta-analysis comparing the technical success and clinical outcomes of endoscopic ultrasound-guided drainage (EUD) and conventional transmural drainage (CTD) for pancreatic pseudocysts. We searched PubMed, Embase, Scopus, and the Cochrane library to identify relevant prospective trials. The technical success rate, short-term (4-6 weeks) success, and long-term (at 6 months) success in symptoms and the radiologic resolution of pseudocysts, complication rates, and death rates were compared. Two eligible randomized-controlled trials and two prospective studies including 229 patients were retrieved. The technical success rate was significantly higher for EUD than for CTD [risk ratio (RR)=12.38, 95% confidence interval (CI): 1.39-110.22]. When CTD failed because of the nonbulging nature of pseudocysts, a crossover was carried out to EUD (n=18), which was successfully performed in all these cases. All patients with portal hypertension and bleeding tendency were subjected to EUD to avoid severe complications. EUD was not superior to CTD in terms of short-term success (RR=1.03, 95% CI: 0.95-1.11) or long-term success (RR=0.98, 95% CI: 0.76-1.25). The overall complications were similar in both groups (RR=0.98, 95% CI: 0.52-1.86). The most common complications were bleeding and infection. There were two deaths from bleeding after CTD. The short-term and long-term treatment success of both methods is comparable only if proper drainage modality is selected in specific clinical situations. For bulging pseudocysts, either EUD or CTD can be selected whereas EUD is the treatment of choice for nonbulging pseudocysts, portal hypertension, or coagulopathy.

背景与目标： : 我们进行了首次荟萃分析，比较了内镜超声引导引流 (EUD) 和常规透壁引流 (CTD) 治疗胰腺假性囊肿的技术成功和临床结果。我们搜索了PubMed，Embase，Scopus和Cochrane图书馆，以确定相关的前瞻性试验。比较了症状的技术成功率，短期 (4-6周) 成功率和长期 (6个月) 成功率以及假性囊肿的放射学分辨率，并发症发生率和死亡率。检索了两项符合条件的随机对照试验和两项包括229名患者的前瞻性研究。EUD的技术成功率明显高于CTD [风险比 (RR)= 12.38，95% 置信区间 (CI): 1.39-110.22]。当由于假性囊肿的非膨出性而导致CTD失败时，对EUD进行了交叉 (n = 18)，在所有这些情况下均成功进行了交叉。所有有门静脉高压症和出血倾向的患者均接受EUD治疗，以避免严重的并发症。就短期成功率 (RR = 1.03，95% CI: 0.95-1.11) 或长期成功率 (RR = 0.98，95% CI: 0.76-1.25) 而言，EUD并不优于CTD。两组的总体并发症相似 (RR = 0.98，95% CI: 0.52-1.86)。最常见的并发症是出血和感染。CTD后有2例死于出血。只有在特定的临床情况下选择适当的引流方式，两种方法的短期和长期治疗成功才具有可比性。对于膨出性假性囊肿，可以选择EUD或CTD，而EUD是治疗非膨出性假性囊肿，门静脉高压症或凝血病的首选方法。

BACKGROUND & AIMS: BACKGROUND:The qualitative anatomy of the distal iliotibial band (ITB) has previously been described. However, a comprehensive characterization of the quantitative anatomic, radiographic, and biomechanical properties of the Kaplan fibers of the deep distal ITB has not yet been established. It is paramount to delineate these characteristics to fully understand the distal ITB's contribution to rotational knee stability. Purpose/Hypothesis: There were 2 distinct purposes for this study: (1) to perform a quantitative anatomic and radiographic evaluation of the distal ITB's attachment sites and their relationships to pertinent osseous and soft tissue landmarks, and (2) to quantify the biomechanical properties of the deep (Kaplan) fibers of the distal ITB. It was hypothesized that the distal ITB has definable parameters concerning its anatomic attachments and consistent relationships to surgically pertinent landmarks with correlating plain radiographic findings. In addition, it was hypothesized that the biomechanical properties of the Kaplan fibers would support their role as important restraints against internal rotation. STUDY DESIGN:Descriptive laboratory study. METHODS:Ten nonpaired, fresh-frozen human cadaveric knees (mean age, 61.1 years; range, 54-65 years) were dissected for anatomic and radiographic purposes. A coordinate measuring device quantified the attachment areas of the distal ITB to the distal femur, patella, and proximal tibia and their relationships to pertinent bony landmarks. A radiographic analysis was performed by inserting pins into the attachment sites of relevant anatomic structures to assess their location relative to pertinent bony landmarks with fluoroscopic guidance. A further biomechanical assessment of 10 cadaveric knees quantified the load to failure and stiffness of the Kaplan fibers' insertion on the distal femur after a preconditioning protocol. RESULTS:Two separate deep (Kaplan) fiber bundles were identified with attachments to 2 newly identified femoral bony prominences (ridges). The proximal and distal bundles inserted on the distal femur 53.6 mm (95% CI, 50.7-56.6 mm) and 31.4 mm (95% CI, 27.3-35.5 mm) proximal to the lateral epicondyle, respectively. The centers of the bundle insertions were 22.5 mm (95% CI, 19.1-25.9 mm) apart. The total insertion area of the distal ITB on the proximal tibia was 429.1 mm2 (95% CI, 349.2-509.1 mm2). A distinct capsulo-osseous layer of the distal ITB was also identified that was intimately related to the lateral knee capsule. Its origin was in close proximity to the lateral gastrocnemius tubercle, and it inserted on the proximal tibia at the lateral tibial tubercle between the fibular head and the Gerdy tubercle. Radiographic analysis supported the quantitative anatomic findings. The mean maximum load during pull-to-failure testing was 71.3 N (95% CI, 41.2-101.4 N) and 170.2 N (95% CI, 123.6-216.8 N) for the proximal and distal Kaplan bundles, respectively. CONCLUSION:The most important finding of this study was that 2 distinct deep bundles (Kaplan fibers) of the distal ITB were identified. Each bundle of the deep layer of the ITB was associated with a newly identified distinct bony ridge. Radiographic analysis confirmed the measurements previously recorded and established reproducible landmarks for the newly described structures. Biomechanical testing revealed that the Kaplan fibers had a strong attachment to the distal femur, thereby supporting a role in rotational knee stability. CLINICAL RELEVANCE:The identification of 2 distinct deep fiber (Kaplan) attachments clarifies the function of the ITB more definitively. The results also support the role of the ITB in rotatory knee stability because of the fibers' vectors and their identified maximum loads. These findings provide the anatomic and biomechanical foundation needed for the development of reconstruction or repair techniques to anatomically address these deficiencies in knee ligament injuries.

背景与目标：

BACKGROUND & AIMS: :In recent years, endobronchial ultrasound-guided TBNA (EBUS-TBNA) has emerged as an innovative technique for diagnosis and staging of lung cancer and has been successfully introduced into daily clinical practice with several advantages including minimally invasive approach, safe, cost-effective, real time image guidance, broad sampling capability, and rapid on-site evaluation (ROSE). Both cytological and histological approach could be useful to have material for diagnosis, immunohistochemical and molecular analyses which may be very important for targeted therapy with successful rate ranging from 89% to 98%. The utility of ROSE during EBUS-TBNA has been matter of debate. Indeed, although some evidence concluded that ROSE does not increase the diagnostic efficacy of EBUS-TBNA, other demonstrated that it improves the diagnostic yield of the procedure up to 30%, allows to avoid repetition of additional diagnostic procedures and reduces risk of complications. Furthermore the sample preparation by cytopathologist is optimized with the aid of direct macroscopic inspection, optimal smearing techniques, and triage of the sample permitting to obtain adequate tissue for diagnosis, ancillary techniques and molecular testing, when needed. Some pathological issues on EBUS-TBNA are reviewed and discussed with particular focus on ROSE and molecular testing.

背景与目标： : 近年来，支气管内超声引导的TBNA (EBUS-TBNA) 已成为肺癌诊断和分期的创新技术，并已成功引入日常临床实践，具有多种优势，包括微创方法，安全，成本效益，实时图像指导，广泛的采样能力，和快速现场评估 (ROSE)。细胞学和组织学方法对于具有用于诊断，免疫组织化学和分子分析的材料可能是有用的，这对于靶向治疗可能非常重要，成功率从89% 到98%。罗斯在EBUS-TBNA期间的效用一直是争论的问题。实际上，尽管一些证据得出结论，ROSE不会增加EBUS-TBNA的诊断功效，但其他证据表明，它可以将手术的诊断产量提高到30%，从而避免重复其他诊断程序并降低并发症的风险。此外，在需要时，通过直接宏观检查，最佳涂片技术和样品分类来优化细胞病理学专家的样品制备，以获得足够的组织进行诊断，辅助技术和分子测试。回顾并讨论了EBUS-TBNA上的一些病理问题，特别着重于玫瑰和分子测试。

BACKGROUND & AIMS: :Patients taking tricyclic antidepressants (TCA) can experience toxicity or severe side effects. As a rapid and less technically demanding alternative to quantitative serum analysis, most laboratories offer qualitative immunoassays to assist in the evaluation of a suspected TCA overdose. However, the relationship between quantitative serum and qualitative urine levels of TCA-related compounds and their metabolites has not been comprehensively studied. Serum high-performance liquid chromatography results were compared to the qualitative urine results using the Syva Rapid Test and the Biosite Triage. Serum concentrations of amitriptyline, desipramine, doxepin, imipramine, and nortriptyline ranging from subtherapeutic to toxic triggered a positive response on both urine immunoassay devices. On the other hand, neither immunoassay uniformly detected clomipramine, even at serum levels greater than the therapeutic range. False positives due to cyclobenzaprine were more common with the Biosite assay. For virtually all positive urine TCA findings, it was not possible to determine whether the positive results corresponded to subtherapeutic, therapeutic, supratherapeutic, or toxic serum concentrations. Because urine immunoassays are the only option for many laboratories analyzing specimens for TCAs (especially in an emergency setting), clinicians must understand the limitations and interpret results in conjunction with clinical findings and/or quantitation of serum levels.

背景与目标： : 服用三环类抗抑郁药 (TCA) 的患者会出现毒性或严重的副作用。作为定量血清分析的快速且技术要求较低的替代方法，大多数实验室提供定性免疫测定，以帮助评估可疑的TCA过量。然而，尚未全面研究TCA相关化合物及其代谢产物的定量血清和定性尿液水平之间的关系。使用Syva快速测试和Biosite分诊将血清高效液相色谱结果与定性尿液结果进行比较。阿米替林，地昔帕明，多塞平，丙咪嗪和去甲替林的血清浓度从亚治疗性到毒性，在两种尿液免疫测定设备上都产生了阳性反应。另一方面，即使在血清水平大于治疗范围的情况下，也没有免疫测定方法能均匀检测到氯米帕明。由于环苯扎林引起的假阳性在生物矿测定中更为常见。对于几乎所有尿液TCA阳性结果，无法确定阳性结果是否对应于亚治疗，治疗，超治疗或毒性血清浓度。由于尿液免疫测定是许多实验室分析TCAs标本的唯一选择 (尤其是在紧急情况下)，因此临床医生必须了解局限性并结合临床发现和/或血清水平定量来解释结果。

BACKGROUND & AIMS: OBJECTIVE:To assess if ultrasound guided autologous blood injection is an effective treatment for medial epicondylitis. METHODS:Twenty patients (13 men, 7 women) with refractory medial epicondylitis with symptom duration of 12 months underwent sonographic evaluation. Tendinosis was confirmed according to three sonographic criteria: echo texture, interstitial tears and neovascularity. The tendon was then dry needled and autologous blood was injected. Patients were reviewed at 4 weeks and at 10 months. VAS scores and modified Nirschl scores were assessed pre-procedure and post-procedure. RESULTS:There was significant reduction in VAS pain score between pre-procedure and 10 months post-procedure when it had a median (IQR) of 1.00 (1-1.75), range 0-7. The median (IQR) Nirschl score, which at pre-procedure was 6.00 (5-7), range 4-7, had decreased at 4 weeks to 4.00 (2.25-5), range 2-7, and at 10 months to 1.00 (1-1.75), range 0-7, revealing a significant decrease (z = 3.763, p<0.001). The hypo-echoic change in the flexor tendon significantly decreased between pre-procedure, when there was a mean (SD) of 6.45 (1.47), and at 10 months, when it was 3.85 (2.37) (p<0.001). Doppler ultrasound showed that neovascularity decreased between pre-procedure, when there was a mean (SD) of 6.10 (1.62), range 4-9, and at 10 months, when it was 3.60 (2.56), range 0-9 (p<0.001). DISCUSSION:The combined action of dry needling and autologous blood injection under ultrasound guidance appears to be an effective treatment for refractory medial epicondylitis as demonstrated by a significant decrease in VAS pain and a fall in the modified Nirschl scores.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Odontocete cetaceans occupy the top position of the marine food-web and are particularly sensitive to the bioaccumulation of lipophilic contaminants. The effects of environmental pollution on these species are highly debated and various ecotoxicological studies have addressed the impact of xenobiotic compounds on marine mammals, raising conservational concerns. Despite its sensitivity, quantitative real-time PCR (qRT-PCR) has never been used to quantify gene induction caused by exposure of cetaceans to contaminants. A limitation for the application of qRT-PCR is the need for appropriate reference genes which allow the correct quantification of gene expression. A systematic evaluation of potential reference genes in cetacean skin biopsies is presented, in order to validate future qRT-PCR studies aiming at using the expression of selected genes as non-lethal biomarkers. RESULTS:Ten commonly used housekeeping genes (HKGs) were partially sequenced in the striped dolphin (Stenella coeruleoalba) and, for each gene, PCR primer pairs were specifically designed and tested in qRT-PCR assays. The expression of these potential control genes was examined in 30 striped dolphin skin biopsy samples, obtained from specimens sampled in the north-western Mediterranean Sea. The stability of selected control genes was determined using three different specific VBA applets (geNorm, NormFinder and BestKeeper) which produce highly comparable results. Glyceraldehyde-3P-dehydrogenase (GAPDH) and tyrosine 3-monooxygenase (YWHAZ) always rank as the two most stably expressed HKGs according to the analysis with geNorm and Normfinder, and are defined as optimal control genes by BestKepeer. Ribosomal protein L4 (RPL4) and S18 (RPS18) also exhibit a remarkable stability of their expression levels. On the other hand, transferrin receptor (TFRC), phosphoglycerate kinase 1 (PGK1), hypoxanthine ribosyltransferase (HPRT1) and beta-2-microglobin (B2M) show variable expression among the studied samples and appear as less suitable reference genes for data normalization. CONCLUSION:In this work, we have provided essential background information for the selection of control genes in qRT-PCR studies of cetacean skin biopsies, as a molecular technique to investigate ecotoxicological hazard in marine mammals. Of 10 HKGs tested, those encoding for YWHAZ and GAPDH appear as the most reliable control genes for the normalization of qRT-PCR data in the analysis of striped dolphin skin biopsies. Potentially useful reference genes are also those encoding for ribosomal proteins L4 and S18.

背景与目标：

BACKGROUND & AIMS: The purpose of this study was to determine if quantitative measurements of regional asynergy add independent prognostic information to global ejection fraction in patients with chronic coronary artery disease. Four hundred eighty-six patients with a history of Q-wave myocardial infarction who underwent gated-equilibrium radionuclide angiography at least 3 months after infarction were monitored for a median duration of 4.7 years. During follow-up there were 95 deaths. Four of five regional asynergy indexes analyzed were associated with overall mortality. The strength of the association between overall mortality and the index that proved to be optimal (univariate chi2 = 26.4, p < 0.001) was stronger than for global ejection fraction (univariate chi2 = 21.5, p < 0.001). For patients with global ejection fraction <40%, 4-year survival was 87% for those with a low asynergy index versus 65% for those with a high asynergy index (p = 0.016). In conclusion, indexes of regional asynergy add independent prognostic information to global left ventricular ejection fraction.

背景与目标： 这项研究的目的是确定区域不同步的定量测量是否为慢性冠心病患者的整体射血分数增加了独立的预后信息。对486例有Q波心肌梗死病史的患者进行了监测，这些患者在梗死后至少3个月接受了门控平衡放射性核素血管造影，中位持续时间为4.7年。在随访期间，有95人死亡。分析的五个区域异步指数中有四个与总体死亡率相关。总死亡率与被证明是最佳的指数 (单变量chi2 = 26.4，p <0.001) 之间的关联强度强于整体射血分数 (单变量chi2 = 21.5，p <0.001)。对于整体射血分数 <40% 的患者，非同步指数低的患者87% 4年生存率，而非同步指数高的患者65% (p = 0.016)。总之，区域非同步指数为整体左心室射血分数增加了独立的预后信息。

BACKGROUND & AIMS: STUDY OBJECTIVES:To determine the total number of active sleep laboratories in the United States and the number of polysomnograms conducted on a yearly basis in these laboratories. METHODS:All members of the AASM and all AASM accredited sleep laboratory directors received a questionnaire addressing their laboratory and its volume. In three states, multiple telephone calls to AASM members were used to correctly identify the absolute number of labs and their PSG volume in those states. Extrapolating from the number of labs studies identified per questionnaire relative to the correct number (per calls) in those states and, then applying this ratio to the entire US, the total number of labs and studies was determined. RESULTS:Our data suggests that there are, in the year 2001, 1,292 sleep laboratories conducting 1,165,135 polysomnograms per year. This comes to 427 PSG's/year per 100,000 population in the United States. CONCLUSIONS:These data suggest that there are a relatively large number of sleep laboratories in the US conducting a substantial number of PSG's. However, there was considerable variability in this volume between states that did not relate to known markers of healthcare utilization. These numbers have likely increased since 2001.

背景与目标：

BACKGROUND & AIMS: :The objective of this study was to determine if very early ultrasonographic measurements obtained from human and baboon are comparable. For this purpose, the gestational, amniotic and yolk sacs, embryonic crown rump length (CRL) and heart rate were measured ultrasonographically between 35 and 47 days from the mean day of a three-day mating period in baboons (n=18) and between 42 to 58 days from fertilization as calculated from the CRL measurements in human pregnancies (n=82). Ultrasonographic measurements from both species were then plotted in the same graph using Carnegie stages of embryonic development as the independent variable to allow for visual comparisons. Mean gestational age at ultrasonographic studies was significantly different for humans and baboons (50.4 vs. 41 days, respectively; p>0.01). Significant correlations (p>0.01) were noted between ultrasonographic measurements and Carnegie stages of development in both humans and baboons. Only the gestational and the yolk sacs were significantly smaller in baboons than in humans (p>0.05). The findings that embryonic CRL, extra-embryonic space and heart rate are very similar between the 17th and 23rd Carnegie developmental stages make the baboon a promising surrogate of human pregnancy for investigations using celocentesis.

背景与目标： : 这项研究的目的是确定从人类和狒狒获得的非常早期的超声检查结果是否具有可比性。为此，妊娠、羊膜和卵黄囊，从狒狒的三天交配期的平均一天 (n = 18) 和受精后的42至58天之间，超声测量了胚胎冠的臀部长度 (CRL) 和心率 (n = 82)。然后使用卡内基胚胎发育阶段作为自变量，将两个物种的超声测量结果绘制在同一图中，以进行视觉比较。在超声检查研究中，人类和狒狒的平均胎龄显着不同 (分别为50.4天与41天; p>0.01)。在人类和狒狒的超声测量与卡内基发育阶段之间发现了显着的相关性 (p>0.01)。狒狒中只有妊娠和卵黄囊明显小于人类 (p>0.05)。在第17和第23卡内基发育阶段之间，胚胎CRL，胚胎外空间和心率非常相似的发现使狒狒成为人类怀孕的有前途的替代品，可用于使用celecentesis进行研究。

BACKGROUND & AIMS: BACKGROUND:High-risk human papillomaviruses (HPVs) cause all cervical cancer and the majority of vulvar, vaginal, anal, penile and oropharyngeal cancers. Although HPV is the most common sexually transmitted infection, public awareness of this is poor. In addition, many clinicians lack adequate knowledge or confidence to discuss sexual transmission and related sensitive issues. Complex science needs to be communicated in a clear, digestible, honest and salient way. Therefore, the aim of this study was to coproduce with patients who have cancer appropriate resources to guide these highly sensitive and difficult consultations. METHODS:A matrix of evidence developed from a variety of sources, including a systematic review and telephone interviews with clinicians, supported the production of a draft list of approximately 100 potential educational messages. These were refined in face-to-face patient interviews using card-sorting techniques, and tested in cognitive debrief interviews to produce a ‘fast and frugal’ knowledge tool. RESULTS:We developed three versions of a consultation guide, each comprising a clinician guidance sheet and patient information leaflet for gynaecological (cervical, vaginal, vulvar), anal or oropharyngeal cancers. That cancer could be caused by a sexually transmitted virus acquired many years previously was surprising to many and shocking to a few patients. However, they found the information clear, helpful and reassuring. Clinicians acknowledged a lack of confidence in explaining HPV, welcomed the clinician guidance sheets and considered printed information for patients particularly useful. CONCLUSION:Because of the ‘shock factor’, clinicians will need to approach the discussion of HPV with sensitivity and take individual needs and preferences into account, but we provide a novel, rigorously developed and tested resource which should have broad applicability in the UK National Health Service and other health systems.

背景与目标：

BACKGROUND & AIMS: :The aim of the study was to investigate the effects of low-intensity pulsed ultrasound (LIPUS) on dentoalveolar structures during application of force to a cultured mandible slice taken from an ovariectomized rat model of osteoporosis. Rats were divided based on whether they had ovariectomy and/or LIPUS application into four groups: control osteoporosis group, control normal group, ultrasound-treated osteoporosis group and ultrasound-treated normal group. The mandibles were dissected, sliced and cultured before application of a 0.5-N force. Tissue specimens from five rats per group received LIPUS; the remaining rats served as untreated controls. Tissue sections were evaluated histologically and histomorphometrically. Osteoporosis significantly affected the alveolar bone without any effect on the dentin-pulp complex. LIPUS enhanced osteoporotic alveolar bone remodeling and increased cementum and predentin thickness. Furthermore, LIPUS application significantly increased odontoblast and periodontal ligament cell counts (p < 0.05) in both groups. Therefore, LIPUS enhances alveolar bone remolding and increases cementum and predentin formation in osteoporotic rat mandible slice organ cultures.

背景与目标： : 该研究的目的是研究低强度脉冲超声 (LIPUS) 对从去卵巢大鼠骨质疏松模型中取出的培养下颌骨切片施加力时对牙槽结构的影响。根据是否进行卵巢切除和/或LIPUS应用将大鼠分为四组: 对照组，正常对照组，超声治疗的骨质疏松症组和超声治疗的正常组。在施加0.5-N力之前，对下颌骨进行解剖、切片和培养。每组五只大鼠的组织标本接受了LIPUS; 其余的大鼠用作未经治疗的对照组。对组织切片进行组织学和组织形态学评估。骨质疏松症显着影响牙槽骨，而对牙本质-牙髓复合体没有任何影响。LIPUS增强了骨质疏松的牙槽骨重塑，并增加了牙骨质和牙本质厚度。此外，在两组中，LIPUS应用显着增加了成牙本质细胞和牙周膜细胞计数 (p <0.05)。因此，在骨质疏松的大鼠下颌骨切片器官培养物中，LIPUS增强了牙槽骨重塑并增加了牙骨质和牙本质形成。