BACKGROUND & AIMS: INTRODUCTION:Prosthetic and operative modifications in total knee arthroplasty (TKA) have been proposed to maximise post-operative knee flexion as it is essential in routine functional activities. METHODS:We performed a double blind randomised controlled trial to compare clinical outcomes of primary cruciate-retaining TKA for osteoarthritis with the femoral component implanted in either 4° flexion in the sagittal plane (F) or in a neutral position (C). The primary outcome of knee flexion and secondary outcomes knee extension, quadriceps strength, WOMAC, SF-12v2, timed stand test, stair climb test and satisfaction were assessed at 1 year. Knee flexion and extension were also assessed intra-operatively. Implant flexion was measured from true lateral radiographs. RESULTS:Thirty-nine participants (40 knees) were recruited, 20 knees per group. Three subjects from the control group and two from the flexed group were lost to 1 year follow-up but numbers were sufficient to satisfy the sample size calculation. Significant differences were found between the groups in knee flexion (F: 113.6±8.8° pre-operative, 122.4±6.0° intra-operative, 110.2±7.5° 1 year, C: 117.4±11.7°, 117.4±7.6°, 103.5±10.7°. p=0.031) and mental component score of the SF12-v2 (F 53.3±13.2, C 61.1±7.3, p=0.009) but there were no significant differences in other outcomes and patients were equally satisfied. CONCLUSION:Flexing the femoral implant in this cruciate retaining TKA system provided a significant difference in knee flexion compared to a neutral position. The improvement appears to occur predominantly at surgery and was not associated with a clinical or functional benefit at 1 year. (ACTRN12606000325505). LEVEL OF EVIDENCE:Level 1; randomised controlled trial.

背景与目标： 简介：已经提出对全膝关节置换术（TKA）进行假体和手术修改，以最大程度地提高术后膝关节屈曲度，因为它是常规功能活动中必不可少的。
方法：我们进行了一项双盲随机对照试验，比较了在骨矢状面（F）或中性位（C）中以4°屈曲度植入股骨组件的原发性保留骨关节炎的TKA的临床结局。在1年时评估膝关节屈曲的主要结果和膝关节伸展，次股四头肌力量，WOMAC，SF-12v2，定时站立测试，爬楼梯测试和满意度的主要结果。术中还评估了膝盖的屈伸性。从真实的侧位X线照片测量植入物的弯曲度。
结果：招募了39名参与者（40膝），每组20膝。对照组的三名受试者和屈肌训练的三名受试者失去了1年的随访，但数量足以满足样本量的计算。两组之间的膝关节屈曲有显着差异（F：术前113.6±8.8°，术中122.4±6.0°，10.2±7.5°1年，C：117.4±11.7°，117.4±7.6°，103.5± SF12-v2的10.7°。p = 0.031）和精神成分评分（F 53.3±13.2，C 61.1±7.3，p = 0.009），但其他结局无显着差异，患者也同样满意。
结论：在这种十字形保持的TKA系统中弯曲股骨植入物与中立位置相比，在膝关节屈曲方面有显着差异。改善似乎主要发生在手术上，并且在1年时与临床或功能获益无关。 （ACTRN12606000325505）。
证据级别：1级；随机对照试验。

BACKGROUND & AIMS: HYPOTHESIS:Perimodiolar intracochlear electrodes with contacts facing towards the modiolus have limited current flow towards the outer wall of the cochlea and therefore, may reduce the occurrence of facial nerve stimulation (FN) in cochlear implant subjects. BACKGROUND:Facial nerve stimulation is a well-known complication in cochlear implant treatment especially in the group of subjects with otosclerosis. The possible explanation of this side effect is a change of the electrical properties of the otosclerotic bone leading to leakage current and resulting in facial nerve stimulation. METHODS:Four CI subjects who had been implanted with a Nucleus Mini22 device with a Nucleus Straight electrode between 9 to 12 years ago suffered from severe FN stimulation. Electrode contacts had to be switched off so that they could only use 4, 11, 13, and 15 electrodes of their usual set of 22. The switch off resulted in deteriorating speech understanding over time. Therefore, all subjects were reimplanted with a Nucleus 24R device with a Contour electrode. Preoperatively, the threshold of FN stimulation was obtained on all electrodes subjectively. Intraoperatively, FN stimulation thresholds were measured objectively with both, the old and the new device and were compared. NRT and SRT thresholds were also obtained with the reimplanted device to assure effective electrical stimulation of the auditory nerve. RESULTS:In all four cases the postoperative fitting demonstrated no FN stimulation on all electrodes up to maximum comfortable level. The insertion of the Contour electrode array was complete in three cases, in one case the array could only be inserted partially similarly to the situation before the reimplantation. Speech perception tests showed a significant improvement in all subjects with the new device. CONCLUSION:Electrodes with modiolar facing contacts and perimodiolar position like the Nucleus Contour electrode reduce the possibility of facial nerve stimulation significantly due to more focused electrical stimulation.

背景与目标： 假设：耳蜗周围的耳蜗内电极面向耳蜗，电流流向耳蜗外壁的电流有限，因此可以减少人工耳蜗植入对象面部神经刺激（FN）的发生。
背景：面神经刺激是耳蜗植入治疗中众所周知的并发症，尤其是在耳硬化症患者群体中。这种副作用的可能解释是耳硬化骨的电特性发生变化，导致漏电流并导致面神经刺激。
方法：4名在9至12年前之间植入带有Nucleus直电极的Nucleus Mini22装置的CI受试者遭受了严重的FN刺激。必须关闭电极触点，以便它们只能使用其通常的22组电极中的4、11、13和15个电极。断开会导致语音理解随着时间的流逝而变差。因此，所有受试者均被植入带有轮廓电极的Nucleus 24R装置。术前，主观地在所有电极上获得FN刺激的阈值。术中用新旧设备客观测量FN刺激阈值，并进行比较。 NRT和SRT阈值也可以通过重新植入的设备获得，以确保对听神经进行有效的电刺激。
结果：在所有四种情况下，术后佩戴均未显示在最大舒适度下所有电极上均未受到FN刺激。在三种情况下，轮廓电极阵列的插入均已完成，在一种情况下，只能与再植入前的情况部分相似地插入阵列。语音感知测试显示，使用新设备后，所有受试者的感觉都有明显改善。
结论：具有模块化的面对面接触和电极周围位置的电极（如Nucleus Contour电极）可通过更加集中的电刺激显着降低面部神经刺激的可能性。

BACKGROUND & AIMS: A variety of experimental models indicate that programmed cell death, or apoptosis, of lymphocytes is a key mechanism in the homeostatic regulation of immunity. Apoptosis is important in early B- and T-cell development to delete cells with nonfunctional antigen receptors, and is also critical for censoring self-reactive cells at the immature lymphocyte stage and at various stages after lymphocytes reach maturity. In this article we focus on the role of the apoptosis regulatory gene bcl-x in controlling survival during lymphocyte development and following B- and T-cell activation. Interesting parallels are observed for bcl-x expression between the B- and T-lineages. The available data also indicate that bcl-x and bcl-2 are expressed in reciprocal patterns during the lifespan of a lymphocyte, suggesting unique regulatory roles for these two survival proteins.

背景与目标： 多种实验模型表明，淋巴细胞程序性死亡或凋亡是免疫稳态调节的关键机制。凋亡在早期B细胞和T细胞发育中很重要，以删除具有非功能性抗原受体的细胞，对于检查未成熟淋巴细胞阶段和淋巴细胞成熟后各个阶段的自反应性细胞也至关重要。在本文中，我们重点研究凋亡调控基因bcl-x在控制淋巴细胞发育以及B细胞和T细胞活化过程中的存活中的作用。在B谱系和T谱系之间观察到bcl-x表达有趣的相似之处。现有数据还表明，bcl-x和bcl-2在淋巴细胞的生命周期中以相互表达的方式表达，表明这两种存活蛋白具有独特的调节作用。

BACKGROUND & AIMS: BACKGROUND:The fourth Millennium Development Goal (MDG) calls for a two-thirds' reduction between 1990 and 2015 in deaths of children younger than five years; achieving this will require widespread use of effective interventions, especially in poor countries. We present the first report of the Child Survival Countdown, a worldwide effort to monitor coverage of key child-survival interventions in 60 countries with the world's highest numbers or rates of child mortality. METHODS:In 2005, we developed a profile for each of the 60 countries to summarise information on coverage with essential child survival interventions. The profiles also present information on demographics, nutritional status, major causes of death in children under 5 years of age, and the status of selected health policies. Progress toward the fourth MDG is summarised by comparing the average annual rate of reduction in under-5 mortality in each country with that needed to achieve the goal. The profiles also include a comparison of the proportions of children in the poorest and richest quintiles of the population who received six or more essential prevention interventions. Each country's progress (as measured by defined indicators of intervention coverage) was put into one of three groups created on the basis of international targets: "on track"; "watch and act"; and "high alert". For indicators without targets, arbitrary thresholds for high, middle, and low performance across the 60 countries were used as a basis for categorisation. FINDINGS:Only seven countries are on track to met MDG-4, 39 countries are making some progress, although they need to accelerate the speed, and 14 countries are cause for serious concern. Coverage of the key child survival interventions remains critically low, although some countries have made substantial improvements in increasing the proportion of mothers and children with access to life saving interventions by as much as ten percentage points in 2 years. Children from the poorest families were less likely than those from wealthier families to have received at least six essential prevention interventions. INTERPRETATION:Our results show that tremendous efforts are urgently needed to achieve the MDG for child survival. Profiles for each country show where efforts need to be intensified, and highlight the extent to which prevention interventions are being delivered equitably and reaching poor families. This first report also shows country-specific improvements in coverage and highlights missed opportunities. The "Countdown to 2015" will report on progress every 2 years as a strategy for increasing accountability worldwide for progress in child survival.

背景与目标： 背景：第四项千年发展目标（MDG）要求在1990年至2015年之间将五岁以下儿童的死亡人数减少三分之二；要实现这一目标，就需要广泛使用有效的干预措施，尤其是在贫穷国家。我们将提交儿童生存倒计时的第一份报告，这是一项全球性的工作，目的是监测儿童死亡率或死亡率最高的60个国家/地区中主要儿童生存干预措施的覆盖率。
方法：2005年，我们为60个国家/地区中的每个国家/地区建立了概况，以总结有关基本儿童生存干预措施覆盖面的信息。简介还提供有关人口统计学，营养状况，5岁以下儿童主要死亡原因以及某些卫生政策状况的信息。通过将每个国家5岁以下儿童死亡率的年均降低速度与实现该目标所需的速度进行比较，总结了实现第四项千年发展目标的进展。概况还包括比较接受六种或更多种基本预防干预措施的最贫穷和最富有的五分之一人口中儿童的比例。将每个国家的进展情况（按确定的干预覆盖率指标衡量）归入根据国际目标建立的三个小组之一： “观看并表演”；和“高度戒备”。对于没有指标的指标，将60个国家/地区的绩效中高，中，低水平的任意阈值用作分类的基础。
结果：只有七个国家有望实现MDG-4，尽管有39个国家需要加快速度，但仍取得了一些进展，还有14个国家引起了严重关注。关键的儿童生存干预措施的覆盖率仍然非常低，尽管一些国家在将获得救生干预措施的母亲和儿童的比例在两年内提高了十个百分点方面取得了实质性的改善。最贫穷家庭的孩子比富有家庭的孩子接受至少六项基本预防干预的可能性较小。
解释：我们的结果表明，为实现儿童生存的千年发展目标，迫切需要付出巨大的努力。每个国家的概况显示了需要加强努力的地方，并强调了公平地实施预防干预措施并惠及贫困家庭的程度。该第一份报告还显示了特定国家/地区在覆盖率方面的改进，并重点介绍了错过的机会。 “到2015年倒计时”将每两年报告进展情况，以此作为在全球范围内增加对儿童生存进展的责任感的战略。

BACKGROUND & AIMS: Although Chronic Myeloid Leukaemia (CML) can be treated successfully with allogeneic bone marrow transplantation (BMT), leukaemia relapse remains a significant clinical problem. Molecular monitoring of the post transplant marrow can be useful in predicting relapse particularly in CML patients where the Philadelphia chromosome or its molecular counterpart, the BCR-ABL fusion messenger RNA can be used as a leukaemia specific marker of minimal residual disease (MRD). We have investigated chimaerism (using polymerase chain reaction of short tandem repeat sequences (STR-PCR)) and MRD status (using reverse transcriptase PCR of the BCR-ABL fusion mRNA) in a serial fashion in 18 patients who were in clinical and haematological remission post allogeneic BMT for chronic phase CML. Eleven patients exhibited complete donor chimaerism with no evidence of minimal residual disease. Five patients had transient or low level stable MC. Late MC and MRD was observed in two patients who relapsed > 6 years after T cell depleted BMT for CML. Thus STR-PCR is an appropriate screening test in the post transplant setting for CML patients, but those patients exhibiting mixed haemopoietic chimaerism should also be monitored using a leukaemia specific sensitive molecular assay.

背景与目标： 尽管同种异体骨髓移植（BMT）可以成功治疗慢性粒细胞白血病（CML），但白血病复发仍然是一个重要的临床问题。移植后骨髓的分子监测可用于预测复发，特别是在CML患者中，在费城染色体或其分子对应物BCR-ABL融合信使RNA可以用作白血病特异性标记物（最小残留病（MRD））的CML患者。我们已对18例临床和血液学缓解的患者进行了系列研究（使用短串联重复序列的聚合酶链反应（STR-PCR））和MRD状态（使用BCR-ABL融合mRNA的逆转录酶PCR）进行了调查。后异基因BMT治疗慢性期CML。 11名患者表现出完全的供体嵌合症，没有最小残留病的证据。 5例患者有短暂或低水平的稳定MC。在T细胞耗尽BMT的CML后复发> 6年的两名患者中观察到晚期MC和MRD。因此，STR-PCR是适合于CML患者移植后环境的筛查测试，但对于那些表现出混合造血干细胞病的患者，也应使用白血病特异性敏感分子测定法进行监测。

BACKGROUND & AIMS: :Navicula grimmei and Nitzschia palea occurring almost equally in a mixed population on department moist garden soil surface when maintained in fresh supernatant (of soil-water medium) at pH 7.0, temperature of 26 +/- 1 degree C and under continuous light (intensity of approximately equal to 30 micromol m(-2) s(-1)) in a culture chamber exhibited a similar cell survival period (of 28 d) and percentage (at the beginning 100 % and mid of survival period 65 %) and stop gliding 11 d prior to cell death (with gliding speed reduced in both from 204-330 microm/min at the beginning to 82.5-99 microm/min at the mid of gliding period) irrespective of their size differences. However, a sharp fall in the cell gliding period, gliding cell percentage and speed occurred at various levels (different from cell survival period and percentage) in both diatoms in a similar extent under water stress (2, 4 and 6 % agarized supernatant, liquid supernatant with 0.2-1.0 mol/L NaCl, blot-dryness of cells for 5-15 min), pH extreme of liquid supernatant (< or =5.0, > or =9.0), temperature extremes in liquid supernatant (< or =15, > or =40 degrees C), UV exposure (0.96-5.76 kJ/m2), lack of all nutrients from the medium (double distilled water), darkness or low light intensities (2 and 10 micromol m(-2) s(-1)), presence of 'heavy' metals (Ni, Cu, Zn, Co, Fe, Hg; 1-200 ppm), organic substances in liquid supernatant (DDT, captan, urea, 2,4-D, 100-2000 ppm; thiourea, 50-1000 ppm). N. palea sway (turn around at either ends) or not only when gliding but independent of cell gliding speed, which decreased continuously under all conditions.

背景与目标： ：保持在pH 7.0的新鲜上清液（土壤-水介质）中，温度为26 /-1摄氏度，并在连续光照下（强度为25°C），在部门潮湿的花园土壤表面上的混合种群中，细叶小夜蛾和小白僵菌几乎均等地发生在部门潮湿的花园土壤表面上在培养室中大约等于30 micromol m（-2）s（-1））表现出相似的细胞存活期（28 d）和百分比（在存活期的开始100％和中期65％）并停止滑动细胞死亡前11天（滑行速度从开始时的204-330 microm / min降低到滑行中段的82.5-99 microm / min），无论它们的大小差异如何。然而，在水分胁迫下，两种硅藻的细胞滑行期，细胞滑行百分比和速度均在不同水平（不同于细胞存活期和百分比）急剧下降（2％，4％和6％的琼脂上清液，含0.2-1.0 mol / L NaCl的上清液，细胞印迹干燥5-15分钟），液体上清液的pH极限值（<或= 5.0，>或= 9.0），液体上清液的温度极限值（<或= 15， >或= 40摄氏度），紫外线暴露（0.96-5.76 kJ / m2），缺少培养基中的所有养分（双蒸馏水），黑暗或弱光强度（2和10 micromol m（-2）s（- 1）），液体上清液中存在的``重''金属（镍，铜，锌，钴，铁，汞; 1-200 ppm），有机物（滴滴涕，硫丹，尿素，2,4-滴，100-2000） ppm；硫脲，50-1000 ppm）。帕氏猪笼草摇晃（在两端转动），或者不仅在滑行时摇摆，而且与细胞滑行速度无关，后者在所有情况下都持续下降。

BACKGROUND & AIMS: INTRODUCTION:Cardiopulmonary resuscitation is thought to be a low-yield intervention in cancer patients. In patients with metastatic disease the procedure is thought to be futile. Comprehensive data on survival to discharge in subsets of cancer patients undergoing in-hospital cardiopulmonary resuscitation, however, are lacking. OBJECTIVE:To determine the rate of survival to discharge for adult cancer patients undergoing in-hospital cardiopulmonary resuscitation. METHOD:A systematic search of MEDLINE and our primary sources' references was performed for studies involving in-hospital cardiac arrest, in clearly defined subsets of adult cancer patients, with outcomes that included survival to hospital discharge. RESULTS:Forty-two studies from 1966-2005, comprising 1707 patients met our minimal inclusion criteria. Overall survival to discharge was 6.2%. Survival in patients with localized disease was 9.5%, and in patients with metastatic disease was 5.6%. Analysis of data reported since 1990 reveals a narrowing of the survival gap, with survival rates in patients with localised disease of 9.1%, and in patients with metastatic disease of 7.8%. Survival in patients resuscitated on the general medical/surgical wards was 10.1%, while survival in patients resuscitated on intensive care units (ICUs) was 2.2%. CONCLUSIONS:Overall survival of CPR to hospital discharge in cancer patients compares favorably to survival rates in unselected inpatients. Improved outcomes in recent years in patients with metastatic disease are likely to reflect more selective use of CPR in cancer patients, with the sickest patients deselected.

背景与目标： 简介：心肺复苏被认为是癌症患者的低产干预措施。在患有转移性疾病的患者中，该过程被认为是徒劳的。然而，缺乏关于接受医院内心肺复苏的癌症患者亚群中出院生存率的综合数据。
目的：确定接受院内心肺复苏的成年癌症患者的出院生存率。
方法：对MEDLINE和我们主要来源的参考文献进行系统搜索，以研究涉及明确定义的成年癌症患者亚组中院内心脏骤停的研究，其结果包括生存至出院。
结果：1966年至2005年的42项研究（包括1707名患者）符合我们的最低纳入标准。出院总生存率为6.2％。局部疾病患者的生存率为9.5％，转移性疾病患者的生存率为5.6％。自1990年以来报告的数据分析显示，生存差距正在缩小，局部疾病患者的生存率为9.1％，转移性疾病患者的生存率为7.8％。在普通内科/外科病房复苏的患者的存活率为10.1％，而在重症监护病房（ICU）进行复苏的患者的存活率为2.2％。
结论：癌症患者到出院时CPR的总生存率优于未选择住院患者的生存率。近年来，转移性疾病患者转归的改善可能反映了癌症患者对CPR的更多选择性使用，而最病患者被取消了选择。

BACKGROUND & AIMS: :A prospective evaluation of 333 consecutive patients undergoing isolated mitral valve replacement between 1982 and 1985 was performed to identify the predictors of survival and valve failure. Follow-up between 2 and 6 years postoperatively (mean, 32 +/- 17 months) was 98% complete. Four prostheses were inserted to permit a prospective evaluation of alternative valves: Björk-Shiley mechanical (n = 118), Ionescu-Shiley pericardial (n = 146), Carpentier-Edwards porcine (n = 38), and Hancock pericardial (n = 31). Hospital mortality was 6%, and actuarial survival at 5 years was 74% +/- 5%. Multivariate Cox regression analysis identified advancing age (less than 40 years, 88% +/- 7%; greater than 70 years, 50% +/- 14%) and poor left ventricular function (ejection fraction less than 0.20, 62% +/- 17%; ejection fraction greater than 0.60, 80% +/- 7%) as independent predictors of postoperative survival. Freedom from structural valve dysfunction, prosthetic valve endocarditis, reoperation, and valve-related mortality and morbidity were 86% +/- 4%, 91% +/- 4%, 81% +/- 4%, and 72% +/- 5%, respectively, at 5 years. The actuarial incidence of valve failure was inordinately high with the Hancock pericardial valve (p less than 0.05). Freedom from thromboembolic events (78% +/- 8% at 5 years) was significantly lower in patients with poor ventricular function (ejection fraction (less than 0.20, 54% +/- 20%; ejection fraction greater than 0.60, 73% +/- 11%; p less than 0.05). Survival after mitral valve replacement was determined by age and left ventricular function. Premature failure of the Hancock pericardial valve resulted in an unacceptable rate of valve-related complications.

背景与目标： ：对1982年至1985年间连续333例接受二尖瓣置换的患者进行了前瞻性评估，以明确其生存率和瓣膜衰竭的预测因素。术后2至6年（平均32 /-17个月）的随访完成了98％。插入了四个假体，以对其他瓣膜进行前瞻性评估：Björk-Shiley机械式（n = 118），Ionescu-Shiley心包式（n = 146），Carpentier-Edwards猪（n = 38）和Hancock心包式（n = 31 ）。医院死亡率为6％，5年的精算生存率为74％/-5％。多元Cox回归分析确定年龄提前（小于40岁，88％/-7％;大于70岁，50％/-14％）和左心室功能差（射血分数小于0.20，62％/-17％） ;射血分数大于0.60，80％/-7％）作为术后生存的独立预测指标。摆脱结构性瓣膜功能障碍，人工瓣膜心内膜炎，再次手术以及与瓣膜相关的死亡率和发病率分别为86％/-4％，91％/-4％，81％/-4％和72％/-5％ ，在5年后。汉考克心包瓣膜的瓣膜衰竭的精算发生率异常高（p小于0.05）。心室功能较差的患者（射血分数（小于0.20，54％/-20％；射血分数大于0.60，73％/-11）时，无血栓栓塞事件（5年时为78％/-8％）显着降低％； p小于0.05）。二尖瓣置换术后的存活率由年龄和左心室功能决定，汉考克心包瓣膜过早衰竭导致瓣膜相关并发症的发生率不可接受。