• 【出生时间是否可以预测围产期不良结果?坦桑尼亚在资源贫乏地区进行的基于医院的横断面研究。】 复制标题 收藏 收藏
    DOI:10.1186/s12884-017-1358-9 复制DOI
    作者列表:Mgaya A,Hinju J,Kidanto H
    BACKGROUND & AIMS: BACKGROUND:Inconsistent evidence of a higher risk of adverse perinatal outcomes during off-hours compared to office hours necessitated a search for clear evidence of an association between time of birth and adverse perinatal outcomes. METHODS:A cross-sectional study conducted at a tertiary referral hospital compared perinatal outcomes across three working shifts over 24 h. A checklist and a questionnaire were used to record parturients' socio-demographic and obstetric characteristics, mode of delivery and perinatal outcomes, including 5th minute Apgar score, and early neonatal mortality. Risks of adverse outcomes included maternal age, parity, referral status and mode of delivery, and were assessed for their association with time of delivery and prevalence of fresh stillbirth as a proxy for poor perinatal outcome at a significance level of p = 0.05. RESULTS:Off-hour deliveries were nearly twice as likely to occur during the night shift (odds ratio (OR), 1.62; 95% confidence interval (CI), 1.50-1.72), but were unlikely during the evening shift (OR, 0.58; 95% CI, 0.45-0.71) (all p < 0.001). Neonatal distress (O.R, 1.48, 95% CI; 1.07-2.04, p = 0.02), early neonatal deaths (OR, 1.70; 95% CI, 1.07-2.72, p = 0.03) and fresh stillbirths (OR, 1.95; 95% CI, 1.31-2.90, p = 0.001) were more significantly associated with deliveries occurring during night shifts compared to evening and morning shifts. However, fresh stillbirths occurring during the night shift were independently associated with antenatal admission from clinics or wards, referral from another hospital, and abnormal breech delivery (OR 1.9; 95% CI, 1.3-2.9, p = 0.001, for fresh stillbirths; OR, 5.0; 95% CI 1.7-8.3, p < 0.001, for antenatal admission; OR, 95% CI, 1.1-2.9, p < 0.001, for referral form another hospital; and OR 1.6; 95% CI 1.02-2.6, p = 0.004, for abnormal breech deliveries). CONCLUSION:Off-hours deliveries, particularly during the night shift, were significantly associated with higher proportions of adverse perinatal outcomes, including low Apgar score, early neonatal death and fresh stillbirth, compared to morning and evening shifts. Labour room admissions from antenatal wards, referrals from another hospital and abnormal breech delivery were independent risk factors for poor perinatal outcome, particularly fresh stillbirths.
    背景与目标: 背景:与办公时间相比,非工作时间不利于围产期结局的风险的证据不一致,因此有必要寻找明确的证据来证明出生时间与不良围产期结局之间的关联。
    方法:在一家三级转诊医院进行的横断面研究比较了24小时内三个工作班次的围产期结局。使用检查表和调查表记录产妇的社会人口统计学和产科特征,分娩方式和围产期结局,包括第5分钟的Apgar评分和新生儿早期死亡率。不良结局的风险包括产妇年龄,胎次,转诊状况和分娩方式,并评估了它们与分娩时间和新鲜死产的发生率之间的关联,以作为围产期预后不良的指标,其显着性水平为p = 0.05。
    结果:夜班期间的下班时间交付几率几乎翻倍(几率(OR)为1.62; 95%置信区间(CI)为1.50-1.72),但在晚班期间则不太可能出现(OR为0.58) ; 95%CI,0.45-0.71)(所有p <0.001)。新生儿窘迫(OR,1.48,95%CI; 1.07-2.04,p = 0.02),早期新生儿死亡(OR,1.70; 95%CI,1.07-2.72,p = 0.03)和新鲜死产(OR,1.95; 95% CI,1.31-2.90,p = 0.001)与夜班和早班相比,与夜班期间的分娩更显着相关。但是,夜班期间发生的新鲜死产与从诊所或病房的产前入院,从另一家医院转诊以及异常的臀位分娩独立相关(OR 1.9;新鲜死产的95%CI,1.3-2.9,p = 0.001;或者; 5.0; 95%CI 1.7-8.3,p <0.001(对于产前入院);或95%CI,1.1-2.9,p <0.001,对于从另一家医院转诊;或OR 1.6; 95%CI 1.02-2.6,p = 0.004,用于异常臀位)。
    结论:与早班和晚班相比,非工作时间的分娩,特别是在夜班期间,与较高的围产期不良后果显着相关,包括低的Apgar评分,早期的新生儿死亡和新鲜的死产。从产前病房分娩,从另一家医院转诊以及异常的臀位分娩是围产期预后不良(尤其是新鲜死产)的独立危险因素。
  • 【CD11c在慢性淋巴细胞性白血病中的表达被重新审视,与并发症和生存有关。】 复制标题 收藏 收藏
    DOI:10.1111/ijlh.12695 复制DOI
    作者列表:Umit EG,Baysal M,Durmus Y,Demir AM
    BACKGROUND & AIMS: INTRODUCTION:Chronic lymphocytic leukemia (CLL) is a disorder of mature but dysfunctional monoclonal B cells. Microenvironment, antigenic stimulation and genetical mutations are demonstrated in etiopathogenesis. We aimed to evaluate the expression of CD11c in patients with CLL and its possible clinical significance. METHODS:Data of 259 patients with CLL between 2010 and 2016 in Trakya University Faculty of Medicine, including age at diagnosis, sex, whole blood count, stage, percentage of CLL cells in bone marrow, line of treatments, development of Richter's transformation and secondary tumors, autoimmune complications, IgG level, prognostic cytogenetic analysis, and length of survival were recorded from files. RESULTS:151 patients were male (58.3%) and 108 were male (41.7%). Mean age was 70 (21-92) years. CD11c was observed to be positive (>%20) in 103 patients (39.8%). Development of Richter's transformation, secondary tumors and ITP was significantly frequent in patients with CD11c positivity (P values .000, .003, .000 respectively). Also, IgG levels were significantly lower in this group (P = .000). Hemoglobin level, RAI stage and bone marrow CLL infiltration percentage were statistically related with CD11c (P values .036, .037, .000 respectively). Finally, CD11c was statistically related (in positive group 70 months, negative group 79 months, P = .001). CONCLUSION:CD11c, expressed not only in Hairy cell leukemia but also in dendritic cells, macrophages and monocytes is a differentiation marker for inflammation. Prolonged inflammation in the microenvironment of CLL cells may cause a susceptibility to autoimmune disorders and secondary tumors in CLL, in this way, an increase in mortality.
    背景与目标: 简介:慢性淋巴细胞性白血病(CLL)是一种成熟但功能失调的单克隆B细胞疾病。微环境,抗原刺激和遗传突变已在病因学中得到证实。我们旨在评估CD11c在CLL患者中的表达及其可能的临床意义。
    方法:特拉基亚大学医学院2010年至2016年间259例CLL患者的数据,包括诊断年龄,性别,全血细胞计数,分期,骨髓CLL细胞百分比,治疗方法,里氏转化的发展和继发性从文件中记录肿瘤,自身免疫并发症,IgG水平,预后细胞遗传学分析和生存期。
    结果:男性151例,占58.3%;男性108例,占41.7%。平均年龄为70(21-92)岁。在103例患者中(39.8%)观察到CD11c阳性(>)。 CD11c阳性患者中Richter转化,继发性肿瘤和ITP的发生非常频繁(分别为P值.000,.003,.000)。此外,该组的IgG水平显着降低(P = .000)。血红蛋白水平,RAI分期和骨髓CLL浸润百分比与CD11c具有统计学相关性(P值分别为.036,.037和.000)。最后,CD11c具有统计学相关性(阳性组70个月,阴性组79个月,P = .001)。
    结论:CD11c不仅在毛细胞白血病中表达,而且在树突状细胞,巨噬细胞和单核细胞中表达,是炎症的分化标志。 CLL细胞微环境中的长时间炎症可能会导致自身免疫性疾病和CLL中继发性肿瘤的易感性,从而增加死亡率。
  • 【穿孔素增强蛋白是一种具有细胞毒性的淋巴细胞颗粒的低分子量蛋白,可增强穿孔素裂解。】 复制标题 收藏 收藏
    DOI:10.1006/bbrc.1997.6899 复制DOI
    作者列表:Winkler U,Fraser SA,Hudig D
    BACKGROUND & AIMS: Perforin is a 68 kD protein found in the granules of cytotoxic lymphocytes and is used by lymphocytes to form lethal pores in the membranes of the cells they kill. We and others have found that when perforin is purified, its lytic activity is markedly reduced. ELISAs indicated that our final recovery of perforin protein was excellent. We decided to determine if depletion of other granule proteins contributed to the loss of lytic activity. We isolated perforin to the point where lytic activity was diminished and added back granule proteins that had no lytic activity or detectable (antigenic) perforin. Perforin was isolated by Cu2+-immobilized metal affinity chromatography (IMAC) followed by phenyl-Superose hydrophobic interaction chromatography (HIC). Its lytic activity was enhanced by a low molecular weight (<15 kD) protein, perforin enhancing protein (PEPr). We have isolated PEPr by two methods, HIC and MonoQ. Nonlytic PEPr restored perforin to close to its original lytic activity. A protein similar if not identical to PEPr was also detectable as an 125I-labeled protein associated with lytic perforin. We propose that PEPr acts in conjunction with perforin to form lethal pores and suggest that PEPr may be the rat equivalent of the human cytotoxic lymphocyte protein, granulysin.

    背景与目标: 穿孔素是一种68 kD蛋白,存在于细胞毒性淋巴细胞的颗粒中,被淋巴细胞用来在其杀死的细胞膜上形成致死孔。我们和其他人已经发现,当穿孔素被纯化时,其裂解活性显着降低。 ELISA法表明,我们穿孔蛋白的最终回收率极高。我们决定确定其他颗粒蛋白的消耗是否导致裂解活性降低。我们将穿孔素分离到溶解活性降低的位置,并添加没有溶解活性或可检测(抗原性)穿孔素的颗粒蛋白。通过铜固定化金属亲和色谱法(IMAC),然后进行苯基-Superose疏水相互作用色谱法(HIC)分离穿孔素。低分子量(<15 kD)蛋白,穿孔素增强蛋白(PEPr)增强了其裂解活性。我们通过两种方法HIC和MonoQ分离了PEPr。非溶解性PEPr使穿孔素恢复至接近其原始溶解活性。与PEPr相似但不相同的蛋白质也可以作为与裂解穿孔素相关的125 I标记蛋白质检测出来。我们建议PEPr与穿孔素一起形成致死性毛孔,并建议PEPr可能与人细胞毒性淋巴细胞蛋白颗粒溶素相当。

  • 【月经周期和食欲控制:对体重调节的影响。】 复制标题 收藏 收藏
    DOI:10.1093/humrep/12.6.1142 复制DOI
    作者列表:Dye L,Blundell JE
    BACKGROUND & AIMS: Hormonal fluctuations associated with the menstrual cycle influence appetite control and eating behaviour. Energy intake varies during the reproductive cycle in humans and animals, with a periovulatory nadir and a luteal phase peak. Patterns of macronutrient selection show less consistency but a number of studies report carbohydrate cravings in the premenstrual phase, particularly in women with premenstrual syndrome. The cyclical nature of food cravings are frequently, but not invariably, associated with depression. Fluctuations in appetite, cravings and energy intake during the menstrual cycle may occur in parallel with cyclical rhythms in serotonin, which can be accompanied by affective symptoms. The premenstrual phase can be considered as a time when women are especially vulnerable to overconsumption, food craving and depression; this is often associated with low serotonin activity.

    背景与目标: 与月经周期有关的荷尔蒙波动会影响食欲控制和饮食行为。在人类和动物的生殖周期中,能量的摄入量会有所不同,排卵期的最低点和黄体期相峰值。大量营养素选择的模式显示出较低的一致性,但是许多研究报告说在经前期对碳水化合物的渴望,特别是在经前期综合症的女性中。渴望食物的周期性通常与抑郁症有关,但并非总是如此。月经周期中食欲,食欲和能量摄入的波动可能与5-羟色胺的周期性节律同时发生,并伴有情感症状。经期可以被认为是妇女特别容易遭受过度消费,食物渴望和沮丧的时期。这通常与5-羟色胺活性低有关。

  • 【恒河猴从出生到成年的肺泡数量增加,但大小没有增加。】 复制标题 收藏 收藏
    DOI:10.1152/ajplung.00467.2006 复制DOI
    作者列表:Hyde DM,Blozis SA,Avdalovic MV,Putney LF,Dettorre R,Quesenberry NJ,Singh P,Tyler NK
    BACKGROUND & AIMS: :Postnatal developmental stages of lung parenchyma in rhesus monkeys is about one-third that of humans. Alveoli in humans are reported to be formed up to 8 yr of age. We used design-based stereological methods to estimate the number of alveoli (N(alv)) in male and female rhesus monkeys over the first 7 yr of life. Twenty-six rhesus monkeys (13 males ranging in age from 4 to 1,920 days and lung volumes from 41.7 to 602 cm(3), 13 females ranging in age from 22 to 2,675 days and lung volumes from 43.5 to 380 cm(3)) were necropsied and lungs fixed, isotropically oriented, fractionated, sampled, embedded, and sectioned for alveolar counting. Parenchymal, alveolar, alveolar duct core air, and interalveolar septal tissue volumes increased rapidly during the first 2 yr with slowed growth from 2 to 7 yr. The rate of change was greater in males than females. N(alv) also showed consistent growth throughout the study, with increases in N(alv) best predicted by increases in lung volume. However, mean alveolar volume showed little relationship with age, lung volume, or body weight but was larger in females and showed a greater size distribution than in males. Alveoli increase in number but not volume throughout postnatal development in rhesus monkeys.
    背景与目标: :恒河猴的肺实质的产后发育阶段约为人类的三分之一。据报道,人类肺泡的形成年龄高达8岁。我们使用基于设计的立体方法来估计生命的前7年中雄性和雌性恒河猴的肺泡(N(alv))数量。 26只猕猴(13只雄性,年龄从4到1,920天不等,肺活量从41.7到602 cm(3),13只雌性,年龄从22到2,675天不等,肺活量从43.5到380 cm(3))进行尸检并固定肺,各向同性,分馏,取样,包埋和切片,以进行肺泡计数。在最初的2年中,实质,肺泡,肺泡导管核心空气和肺泡间隔组织的体积迅速增加,而从2到7年的生长缓慢。男性的变化率大于女性。在整个研究过程中,N(alv)也显示出一致的增长,其中N(alv)的增加最好通过肺体积的增加来预测。但是,平均肺泡容量与年龄,肺活量或体重关系不大,但女性比男性更大,并且大小分布比男性更大。在猕猴的整个产后发育过程中,肺泡的数量增加,但体积没有增加。
  • 【加拿大多胎妊娠的发生率和并发症:专家会议的程序。】 复制标题 收藏 收藏
    DOI:10.1016/s1472-6483(10)60681-5 复制DOI
    作者列表:
    BACKGROUND & AIMS: :This paper reports the proceedings of a consensus meeting on the incidence and complications of multiple gestation in Canada. In addition to background presentations about current and possible future practice in Canada, the expert panel also developed a set of consensus points. The need for infertility to be understood, and funded, as a healthcare problem was emphasized, along with recognition of the emotional impact of infertility. It was agreed that the goal of assisted reproduction treatment is the delivery of a single healthy infant and that even though many positive outcomes have resulted from twin or even triplet pregnancies, the potential risks associated with multiple pregnancy require that every effort be made to achieve this goal. The evidence shows that treatments other than IVF (such as superovulation and clomiphene citrate) contribute significantly to the incidence of multiple pregnancy. There is an urgent need for studies to understand better the usage and application of these other fertility technologies within Canada, as well as the non-financial barriers to treatment. The final consensus of the expert panel was that with adequate funding and good access to treatment, it will be possible to achieve the goal of reducing IVF-related multiple pregnancy rates in Canada by 50%.
    背景与目标: :本文报道了关于加拿大多胎妊娠的发生率和并发症的共识会议的会议记录。除了关于加拿大目前和将来可能的做法的背景介绍之外,专家小组还制定了一系列共识点。作为医疗保健问题,人们需要理解和资助不育症,并认识到不育症的情感影响。一致认为,辅助生殖治疗的目标是分娩一个健康的婴儿,即使双胞胎或什至三胞胎妊娠产生了许多积极的结果,但与多次妊娠相关的潜在风险仍需要尽一切努力来实现。目标。证据表明,除IVF之外的其他治疗(例如超排卵和柠檬酸克罗米芬)对多胎妊娠的发生率有显着影响。迫切需要进行研究以更好地了解加拿大其他这些生育技术的使用和应用,以及治疗的非财务障碍。专家小组的最终共识是,只要有足够的资金和良好的治疗机会,就有可能实现将加拿大IVF相关的多胎妊娠率降低50%的目标。
  • 【体育活动在产生和维持体重减轻中的作用。】 复制标题 收藏 收藏
    DOI:10.1038/ncpendmet0554 复制DOI
    作者列表:Catenacci VA,Wyatt HR
    BACKGROUND & AIMS: :The majority of randomized, controlled trials (RCTs) show only modest weight loss with exercise intervention alone, and slight increases in weight loss when exercise intervention is added to dietary restriction. In most RCTs, the energy deficit produced by the prescribed exercise is far smaller than that usually produced by dietary restriction. In prospective studies that prescribed high levels of exercise, enrolled individuals achieved substantially greater weight loss-comparable to that obtained after similar energy deficits were produced by caloric restriction. High levels of exercise might, however, be difficult for overweight or obese adults to achieve and sustain. RCTs examining exercise and its effect on weight-loss maintenance demonstrated mixed results; however, weight maintenance interventions were usually of limited duration and long-term adherence to exercise was problematic. Epidemiologic, cross-sectional, and prospective correlation studies suggest an essential role for physical activity in weight-loss maintenance, and post hoc analysis of prospective trials shows a clear dose-response relationship between physical activity and weight maintenance. This article reviews the role of physical activity in producing and maintaining weight loss. We focus on prospective, RCTs lasting at least 4 months; however, other prospective trials, meta-analyses and large systematic reviews are included. Limitations in the current body of literature are discussed.
    背景与目标: :大多数随机,对照试验(RCT)仅通过运动干预仅显示适度的体重减轻,而将运动干预与饮食限制相结合时,体重减轻则略有增加。在大多数随机对照试验中,通过处方运动产生的能量缺乏症远小于通常通过饮食限制产生的能量缺乏症。在规定进行高水平运动的前瞻性研究中,与通过热量限制产生类似能量不足所导致的体重减轻相比,已入组个体的体重减轻显着更大。但是,对于超重或肥胖的成年人来说,高强度的运动可能难以实现和维持。研究运动及其对减肥维持的影响的随机对照试验结果不一。然而,维持体重的干预措施通常持续时间有限,长期坚持锻炼存在问题。流行病学,横断面和前瞻性相关研究表明,体育锻炼对维持体重减轻至关重要,而对前瞻性试验的事后分析表明,体育锻炼与维持体重之间存在明显的剂量反应关系。本文回顾了体育锻炼在产生和维持体重减轻中的作用。我们专注于持续至少4个月的预期RCT;但是,还包括其他前瞻性试验,荟萃分析和大型系统评价。讨论了当前文献的局限性。
  • 【髋臼周围骨盆切开术后的并发症和患者满意度。】 复制标题 收藏 收藏
    DOI:10.1007/s00264-007-0372-3 复制DOI
    作者列表:Biedermann R,Donnan L,Gabriel A,Wachter R,Krismer M,Behensky H
    BACKGROUND & AIMS: :Periacetabular osteotomy (PAO) is a well established method to treat hip dysplasia in the adult. There is, however, a lack of information on the subjective outcome of patients with complications after PAO. The purpose of this study was therefore to assess the influence of complications on the patients' post-operative wellbeing and function: 60 PAOs on 50 patients were investigated retrospectively after a mean follow-up of 7.4 years. The patients' self-reported assessment of health and function was evaluated by the Medical Outcomes Short Form-36 (SF-36) and the Western Ontario and McMaster Universities (WOMAC) questionnaires at last follow-up. Forty healthy persons served as a control group. Of the 60 interventions 13 had no complications. Minor complications occurred in 25 (41%) and in 22 (37%) at least one major complication occurred. SF-36 summary measure was 76.4 for PAO patients and 90.3 for the control group. Mean WOMAC score was 25.1. Patients with major complications had a similar subjective outcome as patients with minor or without complications, but persistent dysaesthesia due to lateral femoral cutaneous nerve dysfunction led to a worse subjective function. Lesions of the lateral femoral cutaneous nerve have much greater influence on patients' self-assessed functional outcome after PAO than previously reported and greater attention has to be given to this supposedly minor complication.
    背景与目标: 小前截骨术(PAO)是一种成熟的治疗成人髋关节发育不良的方法。但是,缺乏有关PAO术后并发症患者的主观结果的信息。因此,本研究的目的是评估并发症对患者术后健康和功能的影响:平均随访7.4年后,对50例患者的60个PAO进行了回顾性研究。在最后一次随访时,通过医学成果简表36(SF-36)和西安大略和麦克马斯特大学(WOMAC)的问卷对患者的健康和功能自我评估进行了评估。 40名健康人作为对照组。在60项干预措施中,有13项没有并发症。轻微并发症发生在25(41%)和22(37%)中,至少发生了一次重大并发症。 SF-36总结指标为PAO患者为76.4,对照组为90.3。 WOMAC平均得分为25.1。具有严重并发症的患者的主观结局与具有轻微并发症或无并发症的患者相似,但由于股外侧皮神经功能障碍导致的持续感觉异常导致主观功能变差。股外侧皮神经病变对PAO后患者自我评估的功能结局的影响要比以前报道的要大得多,因此必须对这种所谓的轻微并发症给予更大的关注。
  • 【肺移植后早期和晚期气道并发症:发生率和处理。】 复制标题 收藏 收藏
    DOI:10.1016/s0003-4975(97)83852-0 复制DOI
    作者列表:Kshettry VR,Kroshus TJ,Hertz MI,Hunter DW,Shumway SJ,Bolman RM 3rd
    BACKGROUND & AIMS: BACKGROUND:Airway anastomosis complications continue to be a source of morbidity for lung transplant recipients. METHODS:This study analyzes incidence, treatment, and follow-up of airway anastomotic complications occurring in 127 consecutive lung transplant airway anastomoses (77 single lung and 25 bilateral sequential lung). Complications were categorized as stenosis (11), granulation tissue (8), infection (7), bronchomalacia (5), or dehiscence (3). Follow-up after treatment ranged from 6 months to 4 years. RESULTS:Nineteen airway anastomosis complications (15.0%) occurred in 18 patients. Telescoping the airway anastomosis reduced the complication rate to 12 of 97 (12.4%), compared with 7 of 30 (23.3%) for omental wrapping, (p = 0.15). Complications developed in 13 of 77 single-lung airway anastomoses (16.9%) versus 6 of 50 bilateral sequential lung recipients (12.0%). Treatment consisted of stenting (9 airway anastomoses), bronchodilation (8), laser debridement (4), rigid bronchoscopic debridement (2), operative revision (2), and growth factor application (2). There was no difference in actuarial survival between patients with or without airway anastomosis complications (p = 1.0). CONCLUSIONS:Airway anastomosis complications can be successfully managed in the immediate or late postoperative period with good outcome up to 4 years after intervention.
    背景与目标: 背景:气管吻合并发症仍然是肺移植接受者发病的来源。
    方法:本研究分析了127例连续的肺移植气道吻合术(77例单肺和25例双侧序贯肺)发生的气道吻合并发症的发生率,治疗和随访情况。并发症分为狭窄(11),肉芽组织(8),感染(7),支气管软化(5)或裂开(3)。治疗后的随访时间为6个月至4年。
    结果:18例患者发生了19例气道吻合并发症(15.0%)。伸缩气道吻合术使并发症发生率降低至97例中的12例(12.4%),而网膜包裹术的并发症发生率为30例中的7例(23.3%)(p = 0.15)。 77例单肺气道吻合中有13例发生了并发症(占16.9%),而50例双侧连续肺接受者中有6例发生了并发症(占12.0%)。治疗包括支架置入术(9例气道吻合术),支气管扩张术(8),激光清创术(4),硬支气管镜清创术(2),手术翻修(2)和生长因子应用(2)。有或没有气道吻合并发症的患者之间的精算生存率无差异(p = 1.0)。
    结论:气道吻合并发症可在术后即刻或晚期成功治疗,干预后长达4年的效果良好。
  • 【神经性厌食症和情感障碍的大脑葡萄糖代谢:体重减轻或抑郁症状的影响。】 复制标题 收藏 收藏
    DOI:10.1016/s0925-4927(97)02971-5 复制DOI
    作者列表:Delvenne V,Goldman S,De Maertelaer V,Wikler D,Damhaut P,Lotstra F
    BACKGROUND & AIMS: :Relationships between eating and affective disorders remain complex and unclear. Brain glucose metabolism of anorectic patients has been demonstrated to be reduced both globally and regionally, with a particular relative hypometabolism in the parietal cortex. To explore the possible influence of weight loss or depressive symptomatology on brain metabolism, we studied age- and sex-matched low-weight anorectic and depressed patients, normal-weight depressed patients, and healthy volunteers. Absolute global and regional glucose activity levels were reduced in low-weight patients, with the lowest values being found for anorectic patients. In relative values, anorectic patients showed a significant parietal hypometabolism in comparison to control subjects while they had higher metabolism in the caudate nuclei when compared with the other groups. Absolute hypometabolism of glucose seems to be a consequence of low weight as it was found in both low-weight anorectic and low-weight depressive patients. In addition, absolute glucose values were significantly correlated with body mass index in all subjects. Future positron emission tomographic studies in psychiatric patients should control for alimentary parameters.
    背景与目标: 饮食和情感障碍之间的关系仍然复杂且不清楚。厌食症患者的脑葡萄糖代谢已被证实在全球和区域范围内均会降低,顶叶皮层中存在特定的相对代谢不足。为了探索减肥或抑郁症状对脑代谢的可能影响,我们研究了年龄和性别相匹配的低体重厌食症和抑郁症患者,正常体重的抑郁症患者以及健康志愿者。低体重患者的全球和区域绝对葡萄糖活性水平降低,而厌食患者的葡萄糖水平最低。在相对价值方面,与对照组相比,厌食患者的顶叶代谢明显降低,而尾核中的新陈代谢较其他组更高。葡萄糖的绝对低代谢似乎是低体重的结果,因为它在低体重厌食症患者和低体重抑郁症患者中均被发现。另外,在所有受试者中,绝对葡萄糖值与体重指数显着相关。未来精神病患者的正电子发射断层扫描研究应控制饮食参数。
  • 【微创冠状动脉旁路移植术中的吻合并发症。】 复制标题 收藏 收藏
    DOI:10.1016/s0003-4975(97)00416-5 复制DOI
    作者列表:Pagni S,Qaqish NK,Senior DG,Spence PA
    BACKGROUND & AIMS: BACKGROUND:Anterior wall myocardial revascularization through a left anterior minithoracotomy is an increasingly accepted procedure. Technical failure at the anastomotic site, promoting persistent or recurrent angina, is known to occur and may be underrecognized. This report summarizes the incidence of technical failure in an initial clinical experience and describes potential causes of early postoperative complications. METHODS:Between December 1995 and May 1996, 15 patients underwent left internal mammary artery-to-left anterior descending artery revascularization without extracorporeal circulation. The surgical indication was single-vessel coronary disease in all patients. We exposed the left anterior descending artery target site through a 10-cm left anterior fourth space thoracotomy. The fourth costal cartilage was resected and the left internal mammary artery was harvested under direct visualization. Two 4-0 polypropylene sutures snared in tourniquets proximal and distal to the anastomotic site were used to obtain a bloodless field and stabilization of the left anterior descending artery. RESULTS:All patients had procedures initially deemed successful based on disappearance of angina or postoperative transthoracic Doppler examination of the internal mammary artery 3 to 5 days postoperatively. However, 3 patients presented with recurrent angina at 2, 6, and 8 weeks. Angiography or direct visualization at operation demonstrated the technical complication (stenosis at the anastomotic site in 2 and snare injury in the native vessel in 1). Two patients required reoperation. CONCLUSIONS:Initial results with minimally invasive coronary bypass grafting have generated great enthusiasm worldwide, but there is no consensus on how the procedure should be performed. These results suggest that a nonstabilized anastomosis results in an unacceptable failure rate. Furthermore, sutures encircling the left anterior descending artery should not be used for vessel stabilization as injury of the artery may occur.
    背景与目标: 背景:通过左前小切口开胸术进行前壁心肌血运重建已成为越来越多的接受方法。众所周知,发生在吻合部位的技术衰竭会导致持续性或复发性心绞痛,并且这种认识可能未得到充分认识。该报告总结了最初临床经验中技术失败的发生率,并描述了术后早期并发症的潜在原因。
    方法:1995年12月至1996年5月,有15例患者进行了左乳内动脉至左前降支血运重建,无体外循环。所有患者的手术适应症均为单支冠状动脉疾病。我们通过一个10厘米的左前第四间隙开胸术暴露了左前降支目标部位。切除第四肋软骨,并在直接观察下收集左乳内动脉。在吻合部位近端和远端的止血带中缠结的两条4-0聚丙烯缝合线用于获得无血流区域并稳定左前降支动脉。
    结果:所有患者均根据术后心绞痛的消失或术后3至5天经胸腔内多普勒检查确定最初的手术成功。但是,有3例患者在第2、6和8周出现了复发性心绞痛。术中的血管造影或直接可视化显示出技术并发症(在吻合口处狭窄2个,在天然血管中圈套器损伤1个)。两名患者需要再次手术。
    结论:微创冠状动脉旁路移植术的初步结果在全世界引起了极大的热情,但是对于该手术的执行方法尚无共识。这些结果表明,不稳定的吻合术会导致不可接受的失败率。此外,环绕左前降支动脉的缝合线不应用于稳定血管,因为可能会发生动脉损伤。
  • 【极低体重婴儿的PBSC采集:单中心体验。】 复制标题 收藏 收藏
    DOI:10.1080/14653240701320270 复制DOI
    作者列表:Sevilla J,Plaza SF,González-Vicent M,Lassaletta A,Ramírez M,Madero L,Díaz MA
    BACKGROUND & AIMS: BACKGROUND:Peripheral blood progenitor cell (PBPC) collection has become the main source of hematopoietic cells for high-dose chemotherapy with stem cell rescue and, in some protocols, for allogeneic hematopoietic transplantation. This procedure is complicated in the smallest children because of difficulties related to their weight, and there is little published experience. We have conducted a prospective study to analyze the incidence of adverse events during PBPC collection in the smallest children (< or = 10 kg). METHODS:From January 2000 to November 2005, 257 leukapheresis were performed in our unit, and 13 of them (5%) in 12 children weighing up to 10 kg (median 9 kg, range 5.8-10.9 kg). RESULTS:Most cases had hypovolemic signs during the procedure (usually tachycardia); six cases had hypotension, five of them with pallor and diaphoresis, and, of those, two also had nausea. In all these cases infusion of saline or plasma volume expanders resolved the clinical findings. In two cases the nausea related to hypocalcemia was resolved after calcium gluconate infusion. Changes in platelet counts were also remarkable, with a median platelet loss of 52%. DISCUSSION:Leukapheresis with continuous-flow cell separators has frequent complications related to volume shift in the smallest children. These adverse events are mild and easily resolved with standard measures for hypovolemia, as plasma expander or normal saline infusions. However, we recommend that the procedure should only be performed by teams with extensive experience in the field.
    背景与目标: 背景:外周血祖细胞(PBPC)收集已成为大剂量化疗,干细胞抢救以及同种异体造血移植中造血细胞的主要来源。对于最小的儿童,由于与体重有关的困难,此过程很复杂,并且几乎没有公开的经验。我们进行了一项前瞻性研究,以分析最小的儿童(<或= 10 kg)在PBPC采集过程中不良事件的发生率。
    方法:从2000年1月至2005年11月,我们单位进行了257例白细胞分离术,其中12例体重不超过10千克(中位数9千克,范围5.8-10.9千克)的儿童中有13例(5%)。
    结果:大多数病例在手术过程中出现低血容量征(通常是心动过速);有6例患有低血压,其中5例患有苍白和发汗,其中2例也有恶心。在所有这些情况下,输注生理盐水或血浆扩容器均可解决临床发现。在两种情况下,葡萄糖酸钙输注后可解决与低钙血症有关的恶心。血小板计数的变化也很显着,中位血小板损失为52%。
    讨论:采用连续流动细胞分离器进行白细胞分离术经常导致最小的儿童发生与体积变化有关的并发症。这些不良事件是轻度的,并且可以通过标准的血容量减少措施轻松解决,例如血浆扩容剂或生理盐水输注。但是,我们建议该程序仅应由在该领域具有丰富经验的团队执行。
  • 【术前使用糖皮质激素减少食管癌食管切除术后并发症的风险:荟萃分析】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Raimondi AM
    BACKGROUND & AIMS: OBJECTIVE:Preoperative glucocorticoid administration has been proposed to reduce postoperative morbidity. This is not frequently done before esophageal resection because of insufficient knowledge on its effectiveness. The purpose was to assess the effects of preoperative glucocorticoid administration in adults undergoing esophageal resection for esophageal carcinoma. METHODS:Studies were identified by searching the Cochrane Controlled Trials Register, Medline, Embase, Scielo and Cochrane Library, and by a manual search for relevant articles. In this systematic review, the last search for clinical trials was performed in December 2005. This review included randomized studies of patients with potentially resectable carcinomas of the esophagus that compared preoperative glucocorticoid administration with placebo. Data were collected by the reviewer, and quality of the trial was assessed using Jadad scoring. Odds ratio with 95% confidence intervals was used to assess the significance of the difference between treatment arms. RESULTS:Four randomized trials involving 169 patients were found. There were no differences in postoperative mortality, anastomotic leakage, hepatic and renal failure between the glucocorticoid and placebo groups. There were fewer postoperative respiratory complications (95% CI= 0.09-0.46), sepsis (95% CI= 0.10-0.81), and total postoperative complications (95% CI=0.06-0.23) with preoperative glucocorticoid administration. CONCLUSION:Prophylactic administration of glucocorticoids is associated with decreased postoperative complications.
    背景与目标: 目的:建议术前给予糖皮质激素可降低术后发病率。由于对食管切除术的有效性了解不足,因此在食管切除术前并不经常这样做。目的是评估术前糖皮质激素对食管癌行食管切除术的成年人的治疗效果。
    方法:通过检索Cochrane对照试验注册簿,Medline,Embase,Scielo和Cochrane图书馆,并通过手动搜索相关文章来鉴定研究。在这项系统评价中,对临床试验的最后一次搜索是在2005年12月进行的。该评价包括对可能切除的食道癌患者进行的随机研究,该研究比较了术前使用糖皮质激素与安慰剂的情况。审阅者收集数据,并使用雅达(Jadad)评分对试验质量进行评估。具有95%置信区间的赔率用于评估治疗组之间差异的显着性。
    结果:共找到四项涉及169例患者的随机试验。糖皮质激素组和安慰剂组之间在术后死亡率,吻合口漏,肝和肾衰竭方面无差异。术前给予糖皮质激素治疗的患者术后呼吸系统并发症(95%CI = 0.09-0.46),败血症(95%CI = 0.10-0.81)和术后并发症总数(95%CI = 0.06-0.23)较少。
    结论:糖皮质激素的预防性给药可减少术后并发症。
  • 【出生时脑膜脊髓腔积液和高腰截瘫的婴儿的预后。道德工作组的评论。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:
    BACKGROUND & AIMS: :The findings presented in an accompanying paper by Menzies, Parkin, and Hey regarding the survival rates and quality of life of babies with severe spina bifida (Lancet 1985 Nov 2; 2(8462): 993-995) prompt the Working Group to reevaluate the ethical guidelines supporting selective treatment proposed in their 1975 report, "Ethics of Selective Treatment of Spina Bifida" (Lancet 1975 Jan 11; 1(7898): 85-88). Although Menzies, et al., report that survival rates are higher than previously expected and that in most cases the children's and parents' lives appear not to be excessively burdensome, the Working Group contends that there "continues to be ethical justification for selective treatment" of such newborns. Since medical, psychological, and social considerations now seem to be "more complex and less clearcut," the Group emphasizes that judgments regarding treatment should be made on a case-by-case basis.
    背景与目标: :孟席斯(Menzies),帕金(Parkin)和黑伊(Hey)随附的论文中有关严重脊柱裂的婴儿的存活率和生活质量的研究结果(《柳叶刀》 1985年11月2日; 2(8462):993-995)促使工作组重新评估支持选择性治疗的道德准则在其1975年的报告“脊柱裂的选择性治疗伦理”中提出(柳叶刀1975年1月11日; 1(7898):85-88)。尽管孟席斯等人报告说,存活率比以前预期的要高,而且在大多数情况下,儿童和父母的生活似乎并不过分负担,但工作组认为,“继续有道德地为选择治疗提供理由”这样的新生儿。由于现在医学,心理和社会方面的考虑似乎“更加复杂且不那么明确”,专家组强调有关治疗的判断应视具体情况而定。
  • 【改变生活方式和行为疗法可有效减轻肥胖的非糖尿病精神分裂症患者的体重,并增加其血清脑源性神经营养因子的水平。】 复制标题 收藏 收藏
    DOI:10.1016/j.psychres.2012.11.020 复制DOI
    作者列表:Kuo FC,Lee CH,Hsieh CH,Kuo P,Chen YC,Hung YJ
    BACKGROUND & AIMS: :The goal of the study was to elucidate the relationship between serum circulating brain-derived neurotrophic factor (BDNF) and body weight reduction via lifestyle modification and behavior therapy in obese non-diabetic patients with chronic schizophrenia. Thirty-three obese non-diabetic subjects with schizophrenia treated with stable antipsychotic medication in a day-care unit for at least 3 months were recruited. Thirty age-, body weight-matched subjects without psychiatric disorders were enrolled as controls. All participants underwent a 10-week weight reduction program, including lifestyle modification, psychosocial treatment, behavior therapy and exercise in the day-care unit. Blood biochemistry, serum BDNF, adipokine (adiponectin), inflammatory markers (C-reactive protein, tumor necrosis factor-alpha and interleukin-6) and oral glucose tolerance test were evaluated before and after the program. Serum BDNF concentrations were significantly lower among patients with schizophrenia compared to control subjects. Serum BDNF levels were significantly increased following the weight reduction program. Elevations in serum BDNF levels were positively correlated with body weight and body mass index reduction. Altogether, our results demonstrate that a non-pharmacological weight reduction program effectively reduces body weight with significant elevation of serum BDNF levels in obese non-diabetic patients with schizophrenia.
    背景与目标: :该研究的目的是阐明肥胖非糖尿病慢性精神分裂症患者的血清循环脑源性神经营养因子(BDNF)与通过生活方式改变和行为疗法减轻体重之间的关系。招募了33例在日托室中接受稳定抗精神病药物治疗,至少3个月的精神分裂症肥胖非糖尿病患者。纳入30名年龄,体重匹配且无精神疾病的受试者作为对照。所有参与者都接受了为期10周的减肥计划,包括在日间护理室进行的生活方式改变,心理社会治疗,行为疗法和锻炼。在该计划之前和之后,评估了血液生化,血清BDNF,脂肪因子(脂联素),炎性标志物(C反应蛋白,肿瘤坏死因子-α和白介素6)以及口服葡萄糖耐量测试。与对照组相比,精神分裂症患者的血清BDNF浓度显着降低。减重计划后,血清BDNF水平显着增加。血清BDNF水平升高与体重和体重指数降低呈正相关。总而言之,我们的结果表明,在肥胖的非糖尿病精神分裂症患者中,非药物减肥计划可以有效减轻体重,同时血清BDNF水平显着升高。

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