BACKGROUND & AIMS: :It is clear that the optimal clinical outcomes in bladder cancer patients requiring radical cystectomy are related to standard histopathologic variables of tumor grade, stage and lymph node status. However, other less well defined variables are also critical to the successful outcomes of these patients. Patients with muscle invasive bladder cancer and treating physicians should avoid unnecessary and significant treatment delays. In addition, hospital and surgeon-volume/experience are thought to be factors that may too be important components that relate to the clinical outcomes of patients following surgery. Lastly, there is a growing body of literature to support the concept of an appropriate lymphadenectomy at the time of surgery, for both node-positive and node-negative bladder cancer patients. It is becoming more obvious that there are multiple variables involved in the clinical success and outcomes of patients with bladder cancer following radical cystectomy. As treating physicians and surgeons we must be aware of these components to ensure the best outcomes for our patients.

背景与目标： ：很明显，需要根治性膀胱切除术的膀胱癌患者的最佳临床结局与肿瘤分级，分期和淋巴结状态的标准组织病理学变量有关。但是，其他定义欠佳的变量对于这些患者的成功结局也至关重要。患有肌肉浸润性膀胱癌的患者和主治医师应避免不必要和显着的治疗延迟。另外，医院和外科医生的体格/经验被认为是可能也是与手术后患者的临床结果相关的重要组成部分的因素。最后，越来越多的文献支持针对淋巴结阳性和淋巴结阴性的膀胱癌患者在手术时进行适当的淋巴结清扫术的概念。越来越明显的是，根治性膀胱切除术后膀胱癌患者的临床成功和结局涉及多个变量。作为主治医师和外科医生，我们必须意识到这些因素，以确保为我们的患者提供最佳的治疗效果。

BACKGROUND & AIMS: :We have translated RNAs for the two rat asialoglycoprotein receptor polypeptides together in a cell-free system containing dog pancreatic microsomes and immunoprecipitated the products with antibodies that distinguish the two proteins. In this system the proteins oligomerize, as judged by their coprecipitation with either of the subunit-specific antisera. Oligomerization does not occur between subunits synthesized without microsomes or between subunits synthesized on separate microsomes mixed during detergent solubilization. Thus, oligomerization occurs within the microsomal membrane. We calculate that oligomerization proceeds with an efficiency of approximately 85%. The receptor complex appears to represent a specific oligomer because it excludes a third membrane glycoprotein synthesized in the same reaction. Oligomerization of the asialoglycoprotein receptor in vitro should provide a useful system to study the assembly of a membrane-protein complex.

背景与目标： ：我们已经在包含狗胰微粒体的无细胞系统中一起翻译了两种大鼠去唾液酸糖蛋白受体多肽的RNA，并使用区分这两种蛋白的抗体对产品进行了免疫沉淀。在该系统中，蛋白质通过与任何亚基特异性抗血清共沉淀来寡聚。在没有微粒体的情况下合成的亚基之间或在去污剂溶解过程中混合的单独微粒体上合成的亚基之间不会发生低聚。因此，低聚发生在微粒体膜内。我们计算出低聚进行的效率约为85％。受体复合物似乎代表特定的寡聚物，因为它排除了在同一反应中合成的第三膜糖蛋白。脱唾液酸糖蛋白受体的体外低聚应该提供一个有用的系统来研究膜-蛋白复合物的组装。

BACKGROUND & AIMS: :Fine needle aspiration cytology (FNAC) is an important tool in the investigation of thyroid nodules and has few reported complications. We present the first report of recurrent laryngeal nerve palsy arising as a complication of thyroid nodule FNAC. This complication led to inaccurate diagnosis and unnecessarily radical surgery, with consequent increased morbidity.

背景与目标： ：细针穿刺细胞学检查（FNAC）是研究甲状腺结节的重要工具，很少有并发症报道。我们目前作为喉结节FNAC的并发症而出现的喉返神经麻痹的首次报道。这种并发症导致诊断不准确和不必要的根治性手术，从而增加发病率。

BACKGROUND & AIMS: OBJECTIVES:The role of surgery in stage IV gallbladder (GB) cancer is not well established. This study analyses prognostic factors in patients with stage IV GB cancer following surgical resection with the aim of identifying a subgroup of patients who might benefit from surgical resection. METHODS:Clinicopathological details were analysed for 94 patients who were surgically treated for stage IV GB cancer at Seoul National University Hospital. RESULTS:Median survival was 8 months in patients with either stage IVa or IVb disease. Sixteen patients (17.0%) underwent resection with curative intent, which increased overall survival over that in patients undergoing palliative surgery (P < 0.001). No survival benefit was seen following surgery with curative intent in patients with stage IVa disease (P = 0.764). Surgery with curative intent resulted in a survival benefit in patients with stage IVb disease, patients with an isolated liver metastasis near the GB bed (median survival: 31 months vs. 9 months; P < 0.001) and patients with limited numbers of peritoneal implantations (median survival: 20 months vs. 6 months; P = 0.002). Preoperative serum carcinoembryonic antigen (CEA) (P = 0.018), surgery with curative intent (P = 0.045) and adjuvant chemotherapy (P = 0.002) were independent prognostic factors in patients with stage IV GB cancer. CONCLUSIONS:Surgery in combination with systemic chemotherapy may be beneficial in carefully selected patients with stage IVb GB cancer.

背景与目标： 目的：手术在IV期胆囊癌中的作用尚不明确。这项研究分析了手术切除后Ⅳ期GB期癌症患者的预后因素，目的是确定可能从手术切除中受益的患者亚组。
方法：分析了首尔国立大学医院94例行IV型GB癌症手术治疗的患者的临床病理学细节。
结果：IVa或IVb期患者的中位生存期为8个月。 16例（17.0％）接受根治性切除术的患者，与接受姑息手术的患者相比，总体生存率有所提高（P <0.001）。 IVa期疾病患者经根治性手术后未见生存获益（P = 0.764）。具有治愈意图的手术可为IVb期疾病患者，GB床附近发生单纯肝转移的患者（中位生存期：31个月对9个月； P <0.001）和腹膜植入次数有限的患者带来生存益处（中位生存期：20个月与6个月； P = 0.002）。 Ⅳ期GB期癌症患者的术前血清癌胚抗原（CEA）（P = 0.018），有根治性手术（P = 0.045）和辅助化疗（P = 0.002）是独立的预后因素。
结论：外科手术结合全身化学疗法可能对精心挑选的IVb GB期癌症患者有益。

BACKGROUND & AIMS: :Interfaces provide the structural basis of essential bone functions. In the hierarchical structure of bone tissue, heterogeneities such as porosity or boundaries are found at scales ranging from nanometers to millimeters, all of which contributing to macroscopic properties. To date, however, the complexity or limitations of currently used imaging methods restrict our understanding of this functional integration. Here we address this issue using label-free third-harmonic generation (THG) microscopy. We find that the porous lacuno-canalicular network (LCN), revealing the geometry of osteocytes in the bone matrix, can be directly visualized in 3D with submicron precision over millimetric fields of view compatible with histology. THG also reveals interfaces delineating volumes formed at successive remodeling stages. Finally, we show that the structure of the LCN can be analyzed in relation with that of the extracellular matrix and larger-scale structures by simultaneously recording THG and second-harmonic generation (SHG) signals relating to the collagen organization.

背景与目标： ：接口提供基本的骨骼功能的结构基础。在骨组织的分层结构中，发现异质性（例如孔隙度或边界）的范围从纳米到毫米，所有这些都有助于宏观特性。然而，迄今为止，当前使用的成像方法的复杂性或局限性限制了我们对这种功能集成的理解。在这里，我们使用无标记的三次谐波（THG）显微镜来解决此问题。我们发现，多孔的腔管网络（LCN）揭示了骨基质中骨细胞的几何形状，可以在与组织学兼容的毫米视野中以亚微米精度直接以3D可视化。 THG还揭示了描述在连续重塑阶段形成的体积的界面。最后，我们表明，通过同时记录与胶原组织有关的THG和第二谐波产生（SHG）信号，可以分析LCN的结构与细胞外基质的结构和更大尺度的结构。

BACKGROUND & AIMS: :A novel amoeboflagellate, isolated from anoxic sediment samples, is described and named Psalteriomonas lanterna gen. nov., sp. nov. The cells of the flagellate stage show a fourfold rotational symmetry with four nuclei, four ventral grooves and four mastigont systems. Each mastigont has four flagella of equal length. Microtubular roots, striated roots or rhizoplasts and electron-dense structures are associated with their basal bodies. A Golgi apparatus is absent. Organelles surrounded by rough endoplasmic reticulum (RER) are presumably modified mitochondria. Methanogenic endosymbiotic bacteria are closely associated with microbodies and form a central body. Nuclear division shows the characteristics of a closed mitosis. Cells of the amoeboid stage are mononucleated and lack the methanogenic endosymbionts. Reproduction occurs in both stages of the life cycle.

背景与目标： ：描述了一种从缺氧沉积物样品中分离出的新型变形虫，并将其命名为Psalteriomonas Lighthousea gen。十一月，sp。十一月鞭毛阶段的细胞具有四个核，四个腹沟和四个four虫系统的四重旋转对称性。每个齿igo具有四个等长的鞭毛。微管的根，横纹的根或根际和电子致密结构与它们的基体相关。高尔基体不存在。被粗糙的内质网（RER）包围的细胞器可能是修饰的线粒体。产甲烷的内共生细菌与微体密切相关并形成中心体。核分裂显示封闭的有丝分裂的特征。变形虫阶段的细胞是单核的，缺乏产甲烷的内共生菌。繁殖发生在生命周期的两个阶段。

BACKGROUND & AIMS: BACKGROUND:Reductions in admissions for myocardial infarction (MI) have been reported in locales where smoke-free workplace laws have been implemented, but no study has assessed sudden cardiac death in that setting. In 2002, a smoke-free restaurant ordinance was implemented in Olmsted County, Minnesota, and in 2007, all workplaces, including bars, became smoke free. METHODS:To evaluate the population impact of smoke-free laws, we measured, through the Rochester Epidemiology Project, the incidence of MI and sudden cardiac death in Olmsted County during the 18-month period before and after implementation of each smoke-free ordinance. All MIs were continuously abstracted and validated, using rigorous standardized criteria relying on biomarkers, cardiac pain, and Minnesota coding of the electrocardiogram. Sudden cardiac death was defined as out-of-hospital deaths associated with coronary disease. RESULTS:Comparing the 18 months before implementation of the smoke-free restaurant ordinance with the 18 months after implementation of the smoke-free workplace law, the incidence of MI declined by 33% (P < .001), from 150.8 to 100.7 per 100,000 population, and the incidence of sudden cardiac death declined by 17% (P = .13), from 109.1 to 92.0 per 100,000 population. During the same period, the prevalence of smoking declined and that of hypertension, diabetes mellitus, hypercholesterolemia, and obesity either remained constant or increased. CONCLUSIONS:A substantial decline in the incidence of MI was observed after smoke-free laws were implemented, the magnitude of which is not explained by community cointerventions or changes in cardiovascular risk factors with the exception of smoking prevalence. As trends in other risk factors do not appear explanatory, smoke-free workplace laws seem to be ecologically related to these favorable trends. Secondhand smoke exposure should be considered a modifiable risk factor for MI. All people should avoid secondhand smoke to the extent possible, and people with coronary heart disease should have no exposure to secondhand smoke.

背景与目标： 背景：在已实施无烟工作场所法律的地区，已有报道称心肌梗死（MI）的住院人数有所减少，但尚无研究评估该地区的突发性心脏病死亡。 2002年，明尼苏达州的奥尔姆斯特德县实施了无烟餐厅条例，2007年，包括酒吧在内的所有工作场所都实现了无烟。
方法：为了评估无烟法律对人口的影响，我们通过罗切斯特流行病学项目测量了在实施每项无烟条例前后的18个月内，奥尔姆斯特德县的心肌梗死和心源性猝死的发生率。使用严格的标准化标准（依赖于生物标志物，心脏疼痛和心电图的明尼苏达州编码），对所有MI进行持续的抽象和验证。猝死定义为与冠心病相关的院外死亡。
结果：与实施无烟餐厅条例之前的18个月与实施无烟餐厅工作场所法之后的18个月相比，心梗的发生率下降了33％（P <.001），从每15万人的150.8下降到100.7心脏猝死的发生率降低了17％（P = 0.13），从每10万人口中的109.1降至92.0。在同一时期，吸烟率下降，而高血压，糖尿病，高胆固醇血症和肥胖症的发生率则保持不变或上升。
结论：实施无烟法律后，心肌梗死的发生率显着下降，除吸烟率外，社区共干预或心血管危险因素的变化不能解释其发生的程度。由于其他危险因素的趋势似乎无法解释，因此，无烟工作场所法律似乎与这些有利趋势在生态上相关。二手烟暴露应被视为可改变的心梗危险因素。所有人都应尽可能避免二手烟，患有冠心病的人也不应接触二手烟。

BACKGROUND & AIMS: BACKGROUND:This study sought to examine the relationship between tobacco-free policies at worksites to worksite demographics such as company size and geographic location. METHODS:Worksites participating in a worksite wellness workshop were asked to complete a worksite wellness instrument, which provided an assessment of their wellness practices already in place in the worksite, including the degree to which tobacco-free policies were in place at the worksite. RESULTS:At a bivariate level, those more likely to have tobacco-free policies included: urban employers (76.8% versus 50% rural employers, p = 0.0001); large employers (> = 250 employees) (74.3% versus 43.1% small employers (<50 employees), p = 0.0003); and schools (69.4%) and hospitals (61.5%) (versus 35.5%, agricultural/ manufacturing employers, p = 0.0125). At the multivariate level, rural employers (AOR = 0.47, 95% CI 0.23, 0.95) and small employers (AOR = 0.34, 95% CI 0.16, 0.71) had decreased odds, compared to their urban and large employer counterparts, of having tobacco-free policies. CONCLUSIONS:Rural and smaller employers are less likely to have tobacco-free policies than their urban and large counterparts.

背景与目标： 背景：这项研究试图检验工作场所无烟政策与工作场所人口统计信息（例如公司规模和地理位置）之间的关系。
方法：要求参加工作场所健康研讨会的工作人员完成工作场所健康工具，以评估其在工作场所中已经实施的健康实践，包括在工作场所制定无烟政策的程度。
结果：在双变量水平上，更可能实施无烟政策的人群包括：城市雇主（76.8％对50％的农村雇主，p = 0.0001）;大型雇主（> = 250名员工）（74.3％相对43.1％小型雇主（<50名员工），p = 0.0003）;和学校（69.4％）和医院（61.5％）（相比35.5％，农业/制造业用人单位，p = 0.0125）。在多变量水平上，与城市和大型雇主相比，农村雇主（AOR = 0.47，95％CI 0.23，0.95）和小型雇主（AOR = 0.34，95％CI 0.16，0.71）吸烟的几率降低免税政策。
结论：与城市和大型雇主相比，农村和较小的雇主制定无烟政策的可能性较小。

BACKGROUND & AIMS: :DNA nanotechnology takes advantage of the predictability of DNA interactions to build complex DNA-based functional nanoscale structures. However, when DNA functional and responsive units that are based on non-canonical DNA interactions are employed it becomes quite challenging to predict, understand and control their thermodynamics. In response to this limitation, here we demonstrate the use of isothermal urea titration experiments to estimate the free energy involved in a set of DNA-based systems ranging from unimolecular DNA-based nanoswitches to more complex DNA folds (e.g. aptamers) and nanodevices. We propose here a set of fitting equations that allow to analyze the urea titration curves of these DNA responsive units based on Watson-Crick and non-canonical interactions (stem-loop, G-quadruplex, triplex structures) and to correctly estimate their relative folding and binding free energy values under different experimental conditions. The results described herein will pave the way toward the use of urea titration experiments in the field of DNA nanotechnology to achieve easier and more reliable thermodynamic characterization of DNA-based functional responsive units. More generally, our results will be of general utility to characterize other complex supramolecular systems based on different biopolymers.

背景与目标： DNA纳米技术利用DNA相互作用的可预测性来构建基于DNA的复杂功能纳米结构。但是，当使用基于非规范DNA相互作用的DNA功能和响应单元时，预测，理解和控制其热力学变得非常具有挑战性。响应于此限制，在此我们展示了使用等温尿素滴定实验来估算一组基于DNA的系统中涉及的自由能，这些系统的范围从基于单分子DNA的纳米开关到更复杂的DNA折叠（例如适体）和纳米设备。我们在这里提出一套拟合方程，这些方程可以基于沃森-克里克和非规范相互作用（茎-环，G-四链体，三链体结构）分析这些DNA响应单元的尿素滴定曲线，并正确估计它们的相对折叠并在不同的实验条件下结合自由能值。本文所述的结果将为在DNA纳米技术领域中尿素滴定实验的使用铺平道路，以实现基于DNA的功能响应单元的更容易且更可靠的热力学表征。更一般地，我们的结果将可用于表征基于不同生物聚合物的其他复杂的超分子系统。

BACKGROUND & AIMS: :In the isolated rat heart perfused with glucose as substrate, measurements were made of perfusate and tissue lactate and pyruvate concentrations, and of tissue α-glycerophosphate and dihydroxyacetone phosphate concentrations. The conditions studied included increased heart work, anoxia, the addition of insulin, acute alloxan diabetes, chronic streptozotocin diabetes, and the addition of ketone bodies. True intracellular lactate values (estimated from the lactate and sorbitol spaces) and apparent tissue values exceeded perfusate values, showing the existence of a lactate concentration gradient. During anoxia, the lactate gradient diminished. Cytoplasmic free NAD+/NADH ratios calculated from the extracellular lactate/pyruvate ratio were similar to and changed in the same direction as the NAD+/NADH ratios calculated from the tissue α-glycerophosphate/dihydroxyacetone phosphate ratios in non-diabetic hearts. In diabetio hearts, extracellular and tissue lactate/pyruvate ratios gave different values for the cytoplasmic free NAD+/NADH ratios than did tissue α-glycero-phoaphate/dihydroxyacetone phosphate ratios. These discrepancies were associated with accumulation of pyruvate in the perfusate and the tissue. Changes in the extracellular lactate/pyruvate ratio gave a better differentiation between acute heart work and acute anoxia than did changes in the heart lactate/pyruvate ratio. The use of extracellular lactate/ pyruvate measurements in assessing the state of myocardial oxygenation is supported by these observations, provided that nutritional factors are taken into account and the diabetic state is excluded.

背景与目标： ：在以葡萄糖为底物灌注的离体大鼠心脏中，测量灌注液，组织乳酸和丙酮酸的浓度，以及组织α-甘油磷酸和二羟基丙酮磷酸的浓度。研究的疾病包括心脏工作增加，缺氧，胰岛素的添加，急性四氧嘧啶糖尿病，慢性链脲佐菌素糖尿病和酮体的添加。真实的细胞内乳酸值（从乳酸和山梨糖醇空间估算）和表观组织值超过灌注液值，表明存在乳酸浓度梯度。在缺氧期间，乳酸梯度降低。由细胞外乳酸盐/丙酮酸盐比率计算出的细胞质游离NAD / NADH比率与在非糖尿病性心脏中由组织α-甘油磷酸酯/二羟基丙酮磷酸盐比率计算出的NAD / NADH比率相似并且在相同的方向上改变。在糖尿病心脏中，细胞外和组织中乳酸/丙酮酸的比率与组织α-甘油-磷酸盐/二羟基丙酮磷酸盐的比率给出的细胞质游离NAD / NADH比率值不同。这些差异与丙酮酸在灌注液和组织中的积累有关。细胞外乳酸/丙酮酸比的变化比心脏乳酸/丙酮酸比的变化更好地区分了急性心脏功和急性缺氧。这些观察结果支持在评估心肌氧合状态时使用细胞外乳酸/丙酮酸的测量结果，但要考虑到营养因素并且排除糖尿病状态。

BACKGROUND & AIMS: :Serum-free mouse embryo (SFME) cells, derived in medium in which serum is replaced with growth factors and other supplements, display distinctive properties: (i) SFME cells do not lose proliferative potential or show gross chromosomal aberration upon extended culture, (ii) these cells depend on epidermal growth factor for survival; and (iii) SFME cell proliferation is reversibly inhibited by serum. Treatment of SFME cells with serum or transforming growth factor beta led to the appearance of glial fibrillary acidic protein, a specific marker for astrocytes. The appearance of glial fibrillary acidic protein in cultures was reversed upon removal of transforming growth factor beta or serum. Cells with properties similar to SFME cells were also isolated from adult mouse brain. These results suggest a role for transforming growth factor beta in astrocyte differentiation in developing organisms and in response to injury and identify the cell type that has the unusual properties of SFME cells.

背景与目标： ：无血清的小鼠胚胎（SFME）细胞衍生于用生长因子和其他补品替代血清的培养基中，显示出独特的特性：（i）SFME细胞在长期培养后不会丧失增殖潜能或显示总体染色体畸变，（ ii）这些细胞的生存依赖于表皮生长因子； （iii）血清可逆地抑制SFME细胞的增殖。用血清或转化生长因子β处理SFME细胞导致出现神经胶质纤维酸性蛋白（星形胶质细胞的特异性标记物）的出现。去除转化生长因子β或血清后，培养物中胶质原纤维酸性蛋白的出现被逆转。还从成年小鼠脑中分离出具有与SFME细胞相似性质的细胞。这些结果表明，在发育中的生物体中星形胶质细胞分化中转化生长因子β的作用以及对损伤的反应，并鉴定出具有SFME细胞异常特性的细胞类型。

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，其中费城染色体或其分子对应物，BCR-ABL融合信使RNA可用作最小残留疾病（MRD）的白血病特异性标志物。我们以临床和血液学缓解的18例患者为研究对象，连续研究了嵌合症（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）。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: :Systemic infection induces an increase in plasma cortisol which accords approximately with illness severity. However, both basal and synthetic ACTH stimulated cortisol levels are not strong predictors of mortality. Moreover, plasma cortisol levels do not readily define those patients who have been clinically observed to respond, with respect to blood pressure elevation, to exogenous hydrocortisone. It is likely that free cortisol, accounting for 6-20% of circulating total (bound plus free) cortisol has most of the life-saving effects on circulation and metabolism in severe sepsis, as corticosteroid-binding globulin bound and albumin-bound cortisol have reduced access to tissues. In addition, sepsis reduces CBG and albumin levels, hence blunting the effect of increasing illness severity on total cortisol. Our recent studies suggest that free cortisol correlates more closely to sepsis severity than total cortisol and that free cortisol levels can be estimated using the plasma CBG and total cortisol, obviating the need for direct free cortisol measurement. Studies directed at determining if free cortisol is a better guide than total cortisol to the need for hydrocortisone supplementation may be of value.

背景与目标： ：全身性感染可引起血浆皮质醇增加，这与疾病的严重程度大致相符。但是，无论是基础还是人工合成的促肾上腺皮质激素刺激皮质醇水平都不是死亡率的强力预测指标。此外，血浆皮质醇水平不能轻易定义那些在临床上已观察到对血压升高对外源性氢化可的松有反应的患者。游离皮质醇可能占严重脓毒症中循环和代谢的大部分挽救生命的作用，而游离皮质醇占循环总量（结合的+游离的）皮质醇的6-20％，因为与皮质类固醇结合的球蛋白结合和与白蛋白结合的皮质醇具有减少进入组织的机会。此外，败血症可降低CBG和白蛋白水平，从而减弱疾病严重程度对总皮质醇的影响。我们最近的研究表明，游离皮质醇与败血症严重程度的关系比总皮质醇更密切，并且可以使用血浆CBG和总皮质醇来估算游离皮质醇的水平，从而无需直接测量游离皮质醇。旨在确定游离皮质醇是否比总皮质醇更好的指南的研究对于补充氢化可的松的需求可能是有价值的。

BACKGROUND & AIMS: :A technic for total mastectomy with complete axillary dissection has been described. The procedure utilizes division of the pectoralis major muscle between its clavicular and sternal portions, perservation of its innervation, and reconstruction after completion of the dissection. The pectoralis minor muscle is resected. This modification facilitates a thorough axillary dissection, particularly at the apex, while preserving the cosmetic and functional benefits of the Patey operation.

背景与目标： ：已经描述了一种具有完全腋窝清扫术的全乳切除技术。该程序利用胸大肌在锁骨和胸骨部分之间的分割，保留神经支配以及在解剖完成后进行重建。切除胸小肌。这种修改有助于彻底进行腋窝解剖，尤其是在根尖处，同时保留Patey手术的美观和功能优势。

BACKGROUND & AIMS: :Extracellular magnesium ions [Mg2+]o are known to regulate functions of endothelial cells, but whether [Mg2+]o can alter intracellular free ionized magnesium [Mg2+]i in these cells remains unknown. The present studies, using digital imaging microscopy and the Mg2+ fluorescent probe, mag-fura-2, determined effects of elevation of [Mg2+]o on [Mg2+]i in cultured human aortic endothelial cells. With normal Mg2+(1.2 mM)-containing incubation media, [Mg2+]i was 0.51+/-0.04 mM with a heterogeneous distribution. The ratio of [Mg2+]i/[Mg2+]o was 0.52+/-0.07. Elevation of [Mg2+]o up to 4.8 mM increased [Mg2+]i to 0.80+/-0.07 mM in 2-10 min and lowered the ratio of [Mg2+]i/[Mg2+]o to 0.16+/-0.02. Irrespective of the observed increments of [Mg2+]i, a subcellular heterogeneous distribution of [Mg2+]i was always evident in all cells tested. Our results suggest that [Mg2+]o can regulate [Mg2+]i more rapidly than heretofore believed, supporting the hypothesis that extracellular Mg2+ can exert regulatory effects on endothelial cell functions and probably act as extracellular regulatory cations

背景与目标： ：已知细胞外镁离子[Mg2] o调节内皮细胞的功能，但是[Mg2] o是否可以改变这些细胞中的细胞内游离离子化镁[Mg2] i，仍然未知。本研究使用数字成像显微镜和Mg2荧光探针mag-fura-2，确定了培养的人主动脉内皮细胞中[Mg2] o升高对[Mg2] i的影响。在含有正常Mg2（1.2 mM）的培养培养基中，[Mg2] i为0.51 / 0.04 mM，分布不均。 [Mg 2] i / [Mg 2] o的比例为0.52 / -0.07。 [Mg2] o升高至4.8 mM会使[Mg2] i在2-10分钟内增加到0.80 /-0.07 mM，并使[Mg2] i / [Mg2] o的比率降低到0.16 /-0.02。不管观察到的[Mg2] i增量如何，在所有测试的细胞中[Mg2] i的亚细胞异质分布总是很明显的。我们的结果表明，[Mg2] o可以比以前认为的更快地调节[Mg2] i，支持以下假设：细胞外Mg2可以对内皮细胞功能发挥调节作用，并且可能充当细胞外调节阳离子