BACKGROUND & AIMS: BACKGROUND:The literature reports that the learning curve for laparoscopic Roux-en-Y gastric bypass (LRYGBP) is approximately 75-100 cases. This aim of the present study was to evaluate the safety and feasibility of shortening the learning curve for performing LRYGBP by an experienced laparoscopic surgeon. METHODS:This study analyzed retrospectively the first 100 consecutive LRYGBP cases performed by an experienced laparoscopic surgeon between April 2003 and September 2003. The surgeon performed these cases after first assisting in 30 cases, and the first 4 cases were proctored by an experienced laparoscopic bariatric surgeon. Two cases done after previous gastric stapling and Nissen fundoplication were excluded from the study. Outcome variables included operative time, complications, conversion, and mortality. RESULTS:For the first 100 LRYGBP patients, the mean age was 42.6 years (range, 22-62 years) and mean body mass index (BMI) was 47.6 kg/m2 (range, 36-71.8). The complications included 1 case of intestinal leak, 1 case of small bowel obstruction, 6 cases of gastrojejunal stenosis, 8 cases of wound infection, 1 case of wound seroma, and 2 cases of pulmonary embolism, resulting in 1 mortality. One case was converted to an open technique. Over the second 50 cases, there was a significant reduction in mean operative time, to 73 minutes (range, 39-145 minutes) from 113 minutes (range, 54-238 minutes) (P < .0001). However, despite the reduction in complication frequency (no gastrointestinal leak or obstruction, 2 cases of gastrojejunal stenosis, 2 cases of wound infection, no pulmonary embolism/deep venous thrombosis, and no mortality), there was no significant correlation between the mortality, conversion, and complication rates and the surgeon's experience. CONCLUSION:A bariatric surgical practice incorporating LRYGBP can be safely done by an experienced laparoscopic surgeon. With appropriate advanced laparoscopic skills, preparatory steps, proctorship, and adequate volume of cases, the learning curve for performing LRYGBP can be reduced to 50 cases. Further experience is associated with a significant reduction in operative time with acceptable mortality, complication, and conversion rates.

背景与目标： 背景：文献报道腹腔镜Roux-en-Y胃旁路术（LRYGBP）的学习曲线约为75-100例。本研究的目的是评估由经验丰富的腹腔镜外科医生缩短进行LRYGBP学习曲线的安全性和可行性。
方法：本研究回顾性分析了2003年4月至2003年9月由经验丰富的腹腔镜外科医生进行的前100例连续LRYGBP病例。在首次协助30例患者之后，外科医生进行了这些病例，前4例病例由经验丰富的腹腔镜肥胖手术医师指导。该研究排除了先前进行胃吻合术和尼森胃底折叠术后完成的两个病例。结果变量包括手术时间，并发症，转化率和死亡率。
结果：前100名LRYGBP患者的平均年龄为42.6岁（范围22-62岁），平均体重指数（BMI）为47.6 kg / m2（范围36-71.8）。并发症包括肠漏1例，小肠梗阻1例，胃空肠狭窄6例，伤口感染8例，伤口血清肿1例和肺栓塞2例，导致1例死亡。一个案例被转换为开放技术。在后50例中，平均手术时间从113分钟（54-238分钟）减少到73分钟（39-145分钟）（P <.0001）。然而，尽管并发症发生率降低（无胃肠道渗出或阻塞，2例胃肠空肠狭窄，2例伤口感染，无肺栓塞/深静脉血栓形成，无死亡率），但死亡率，转化率之间无显着相关性。 ，并发症发生率和外科医生的经验。
结论：有经验的腹腔镜外科医生可以安全地进行结合了LRYGBP的减肥手术。借助适当的高级腹腔镜检查技巧，准备步骤，指导以及适当的病例数量，可以将进行LRYGBP的学习曲线减少到50例。进一步的经验可以显着减少手术时间，并具有可接受的死亡率，并发症和转化率。

BACKGROUND & AIMS: :Phosphorus MRS was evaluated as a monitor of tumour therapeutic response to the herpes simplex virus thymidine kinase suicide gene therapy paradigm. In vivo 31P spectra were obtained from subcutaneous rat C6 gliomas constitutively expressing the HSVtk gene post treatment with ganciclovir (GCV, 15 mg/kg i.p., twice-daily). Significant regression (p < 0.1) of tumour volume was observed 10 days after beginning GCV administration. However, no changes in tumour pH or energy metabolites from pre-treatment values were observed. High-resolution 31P spectra of tumour extracts revealed a statistically significant reduction in the phosphocholine to phosphoethanolamine ratio six days post-GCV administration. These results indicate that the HSVtk/GCV-induced killing of tumours is not associated with corresponding changes in 31P MRS-observable energy metabolites and pH. The observed reduction in the PE/PC ratio may provide a non-invasive in vivo indicator of therapeutic efficacy.

背景与目标： ：磷MRS被评估为对单纯疱疹病毒胸苷激酶自杀基因治疗范例的肿瘤治疗反应的监测器。从更昔洛韦治疗后组成性表达HSVtk基因的皮下大鼠C6神经胶质瘤获得体内31P光谱（GCV，15 mg / kg i.p.，每天两次）。开始GCV给药10天后，观察到肿瘤体积显着消退（p <0.1）。但是，未观察到肿瘤pH值或能量代谢物相对于治疗前值的变化。肿瘤提取物的高分辨率31P光谱显示，GCV给药后六天，磷酸胆碱与磷酸乙醇胺的比率在统计学上显着降低。这些结果表明，HSVtk / GCV诱导的肿瘤杀伤与31P MRS可观察到的能量代谢产物和pH值的相应变化无关。所观察到的PE / PC比的降低可以提供治疗功效的非侵入性体内指标。

BACKGROUND & AIMS: :Magnetic-activated cell sorting (MACS) using paramagnetic annexin V-conjugated microbeads eliminates spermatozoa with externalized phosphatidylserine, which is considered one of the features of apoptosis. The objective of this study was to evaluate sperm recovery following the use of MACS as a sperm preparation technique. Mature spermatozoa were separated and divided into two fractions: the first was prepared by density gradient centrifugation (DGC) and MACS, while the second was prepared by DGC only. Following MACS, the percentage of cells collected in the annexin-negative fraction was significantly higher than the annexin-positive fraction and the sperm recovery rate was 73.8 +/- 12.1%. In conclusion, the integration of MACS with DGC can be considered as an effective sperm preparation technique that does not lead to significant cell loss. Separating a distinctive population of non-apoptotic spermatozoa with intact membranes may optimize the outcome of assisted reproduction.

背景与目标： ：使用顺磁性膜联蛋白V偶联的微珠进行磁激活细胞分选（MACS），消除了带有外部磷脂酰丝氨酸的精子，这被认为是细胞凋亡的特征之一。这项研究的目的是评估使用MACS作为精子制备技术后的精子回收率。将成熟的精子分离并分为两部分：第一部分通过密度梯度离心（DGC）和MACS制备，而第二部分仅通过DGC制备。进行MACS后，在膜联蛋白阴性组分中收集的细胞百分比显着高于膜联蛋白阳性组分，精子回收率为73.8 / 12.1％。总之，MACS与DGC的整合可以被认为是一种有效的精子制备技术，不会导致明显的细胞损失。用完整的膜分离非凋亡性精子的独特群体可以优化辅助生殖的结果。

BACKGROUND & AIMS: :In this paper we describe a biological indicator which can be used to study the behavior of Vibrio vulnificus, an important molluscan shellfish-associated human pathogen. A V. vulnificus ATCC 27562 derivative that expresses green fluorescent protein (GFP) and kanamycin resistance was constructed using conjugation. Strain validation was performed by comparing the GFP-expressing strain (Vv-GFP) and the wild-type strain (Vv-WT) with respect to growth characteristics, heat tolerance (45 degrees C), freeze-thaw tolerance (-20(o) and -80 degrees C), acid tolerance (pH 5.0, 4.0, and 3.5), cold storage tolerance (5 degrees C), cold adaptation (15 degrees C), and response to starvation. Levels of recovery were evaluated using nonselective medium (tryptic soy agar containing 2% NaCl) with and without sodium pyruvate. The indicator strain was subsequently used to evaluate the survival of V. vulnificus in oysters exposed to organic acids (citric and acetic acids) and various cooling regimens. In most cases, Vv-GFP was comparable to Vv-WT with respect to growth and survival upon exposure to various biological stressors; when differences between the GFP-expressing and parent strains occurred, they usually disappeared when sodium pyruvate was added to media. When V. vulnificus was inoculated into shellstock oysters, the counts dropped 2 log(10) after 11 to 12 days of refrigerated storage, regardless of the way in which the oysters were initially cooled. Steeper population declines after 12 days of refrigerated storage were observed for both iced and refrigerated products than for slowly cooled product and product held under conservative harvest conditions. By the end of the refrigeration storage study (22 days), the counts of Vv-GFP in iced and refrigerated oysters had reached the limit of detection (10(2) CFU/oyster), but slowly cooled oysters and oysters stored under conservative harvest conditions still contained approximately 10(3) and >10(4) CFU V. vulnificus/oyster by day 22, respectively. The Vv-GFP levels in the oyster meat remained stable for up to 24 h when the meat was exposed to acidic conditions at various pH values. Ease of detection and comparability to the wild-type parent make Vv-GFP a good candidate for use in studying the behavior of V. vulnificus upon exposure to sublethal stressors that might be encountered during postharvest handling of molluscan shellfish.

背景与目标： ：在本文中，我们描述了一种生物指示剂，可用于研究创伤弧菌（一种与软体动物贝类有关的重要人类病原体）的行为。使用缀合构建表达绿色荧光蛋白（GFP）和卡那霉素抗性的V. vulnificus ATCC 27562衍生物。通过比较表达GFP的菌株（Vv-GFP）和野生型菌株（Vv-WT）的生长特性，耐热性（45°C），冻融耐受性（-20（o ）和-80摄氏度），耐酸性（pH 5.0、4.0和3.5），冷藏（5摄氏度），冷适应（15摄氏度）和对饥饿的反应。使用有和没有丙酮酸钠的非选择性培养基（胰蛋白酶大豆琼脂含2％NaCl）评估回收水平。该指示菌株随后用于评估暴露于有机酸（柠檬酸和乙酸）和各种冷却方案的牡蛎中创伤弧菌的存活。在大多数情况下，就暴露于各种生物胁迫下的生长和存活而言，Vv-GFP可与Vv-WT媲美。当表达GFP的菌株和亲本菌株之间出现差异时，通常在向培养基中添加丙酮酸钠后它们消失。当将V. vulnificus接种到带壳牡蛎中时，无论最初冷却牡蛎的方式如何，在冷藏11至12天后，其计数都下降了2 log（10）。与冷藏产品和在保守收获条件下保存的产品相比，冷藏和冷藏产品在冷藏存储12天后的直立种群减少。到冷藏存储研究结束时（22天），冰牡蛎和冷藏牡蛎中的Vv-GFP数量已达到检测极限（10（2）CFU /牡蛎），但缓慢冷却的牡蛎和保守收获的牡蛎到第22天时，条件仍分别包含大约10（3）和> 10（4）CFU创伤弧菌/牡蛎。当将牡蛎肉暴露于各种pH值的酸性条件下时，牡蛎肉中的Vv-GFP水平保持稳定长达24小时。 Vv-GFP易于检测且与野生型亲本具有可比性，因此非常适合用于研究在捕食软体动物贝类后可能会遇到的亚致死应激源下的V. vulnificus行为。

BACKGROUND & AIMS: Etoposide produces reversible inhibition of topoisomerase II, leading to cleavage of DNA, and thereby has an antitumor effect. This mechanism suggests that the longer treatment is continued, the greater the antitumor effect will be. In the present study, both therapeutic and adverse effects of long-term treatment with low-dose oral etoposide were studied in 29 patients aged > or = 65 years with non-Hodgkin's lymphoma (NHL) for whom standard chemotherapy was not effective or refractory. These patients received etoposide at a dose of 50 mg/d for as long as possible. Treatment was continued until white blood cell count decreased to < or = 2,000/microL or the platelet count decreased to < or = 5 x 10(4)/microL. According to the World Health Organization (WHO) criteria of therapeutic effects, 6 (20.7%) of the 29 patients achieved complete remission and 13 patients (44.8%) had partial remission, for a response rate of 65.5%. Adverse effects of > or = grade 3 included leukopenia in 24 patients (82.8%) and anemia in 7 (24.1%). Granulocyte colony-stimulating factor (G-CSF) was given in combination with etoposide to eight patients because of leukopenia (granulocyte count < or = 1,000/microL). In view of the excellent subjective tolerance, low incidence of serious adverse effects, and good activity, single agent oral etoposide given continuously over prolonged periods represents a useful treatment for elderly patients with NHL.

背景与目标： 依托泊苷产生对拓扑异构酶II的可逆抑制，导致DNA裂解，因此具有抗肿瘤作用。该机制表明持续的治疗时间越长，抗肿瘤作用越大。在本研究中，对29岁年龄≥65岁的非霍奇金淋巴瘤（NHL）患者进行了长期低剂量口服依托泊苷的治疗，并对其不良反应进行了研究，这些患者对于标准化疗均无效或难治。这些患者尽可能长时间接受依托泊苷50 mg / d的剂量。继续治疗直至白细胞计数降低至<或= 2,000 / microL或血小板计数降低至<或= 5 x 10（4）/ microL。根据世界卫生组织（WHO）的治疗效果标准，这29例患者中有6例（20.7％）完全缓解，13例（44.8％）部分缓解，缓解率为65.5％。 ≥3级的不良反应包括24例白血球减少症（82.8％）和7例贫血（24.1％）。由于白细胞减少症（粒细胞计数<或= 1,000 / microL），八名患者与依托泊苷合用了粒细胞集落刺激因子（G-CSF）。鉴于出色的主观耐受性，严重不良反应的发生率低以及良好的活动性，长时间连续给予单剂口服依托泊苷对老年NHL患者是一种有用的治疗方法。

BACKGROUND & AIMS: OBJECTIVE:Use of the image-guided stereotactic brain biopsy has facilitated the diagnosis of previously inaccessible lesions with both safety and reliability. However, few studies have assessed the diagnostic yield of frozen section evaluation of the initial stereotactic target (FS-0). We describe our experience with 188 stereotactic brain biopsies in order to evaluate the diagnostic yield of FS-0.

DESIGN:Retrospective study of 188 stereotactic brain biopsies from 185 patients.

SETTING:Tertiary referral center with a high volume of neurosurgical cases including image-guided stereotactic brain biopsies.

PATIENTS:One hundred eighty-five patients who underwent imaged-guided stereotactic brain biopsy over a 58-month period.

RESULTS:The patients studied included 107 males and 78 females (mean age 48 years). Eleven (6%) biopsies were nondiagnostic. Diagnoses from FS-0 included a neoplastic condition in 96 (73%) of 131 cases and a nonneoplastic condition in 23 (50%) of 46 cases. In 119 (67%) of 177 cases, a diagnosis was reached at FS-0. A correct diagnosis was made on subsequent frozen section in 28 (16%) of cases, including 21 (16%) of 131 neoplasms and 7 (15%) of nonneoplastic conditions. In 15 (54%) of 28 cases, the correct diagnosis was made on the second frozen section; in 25 (89%) of 28, the correct diagnosis was made by the fourth frozen section. In 14 (11%) of 131 neoplastic cases, a sampling error relative to the lesion resulted in an inaccurate diagnosis at FS-0. A significant error in diagnosis occurred in three cases (1.7%).

CONCLUSIONS:We conclude that (1) because 58 (33%) of 177 diagnosed cases in our series would have been potentially misdiagnosed if only one biopsy had been taken at the stereotactic target, frozen section evaluation or cytologic examination of material at the time of surgery should be performed routinely to ensure that adequate tissue has been obtained for purposes of diagnosis; (2) taking up to four biopsies increases the diagnostic yield (from 67% to 89% in this series); and (3) neoplastic lesions are more likely to be definitively diagnosed at FS-0 than non-neoplastic lesions.

背景与目标： 目标：使用图像引导的立体定向脑活检技术，既安全又可靠，有助于诊断先前难以接近的病变。但是，很少有研究评估初始立体定位目标（FS-0）的冷冻切片评估的诊断率。为了描述FS-0的诊断结果，我们描述了188例立体定向脑活检的经验。

DESIGN ：对185例患者的188例立体定向脑活检进行了回顾性研究。
设置：拥有大量神经外科病例的三级转诊中心，包括图像引导的立体定向脑活检。

患者：一百八十五

结果：接受影像引导的立体定向脑活检的患者。研究的患者包括107例男性和78例女性（平均年龄48岁）。 11例（6％）活检未确诊。 FS-0的诊断包括131例中的96例（73％）为肿瘤性疾病和46例中23例（50％）为非肿瘤性疾病。在177例病例中，有119例（67％）达到了FS-0的诊断。在随后的冰冻切片中，有28例（16％）做出了正确的诊断，包括131例肿瘤中的21例（16％）和7例（15％）的非肿瘤性疾病。在28例病例中，有15例（54％）对第二个冷冻切片做出了正确的诊断。 28例中有25例（89％）通过第四次冰冻切片做出了正确的诊断。在131例肿瘤病例中，有14例（11％）相对于病变的采样错误导致FS-0诊断不准确。结论3例诊断错误（1.7％）。

结论：我们得出结论：（1）因为本系列177例诊断病例中有58例（33％）如果仅在立体定向目标上进行了一次活检，可能会被误诊，在手术时应常规进行冰冻切片评估或材料的细胞学检查，以确保获得足够的组织用于诊断； （2）最多进行四次活检可以提高诊断率（在本系列中从67％增至89％）； （3）FS-0比非肿瘤性病变更有可能明确诊断出肿瘤性病变。