[Regeneration of costal cartilage by pectus excavatum and thoracic cage remodeling]

In order to identify whether the regeneration of costal cartilage is the basis of post-surgical repair of pectus excavatum and thoracic cage remodeling, 151 cases were followed up for 0.25 to 14 years. The main procedures in treatment were 3 steps: To curve the mental strut as a bow, to repair the perichondrium as a tube, and to persist in post-operative therapy. The results showed that regeneration of the costal cartilages appeared 3 months postoperatively in the cases treated by this method. It was concluded that a satisfactory thoracic cage could be remodeled by improving the technique of repairing pectus excavatum and persisting in postoperative therapy according to the regeneration regularity.

[Esophageal reconstruction using ilecolon in children--a report of ten cases]

The use of the ileocolon as a substitute for esophagus in children has been a well-established surgical procedure. Between 1992 and 1995, ten retrosternal esophageal substitutions using an ileocolic interposition were performed. The ages of the children ranged from 2 to 8 years. The esophageal strictures were secondary to ingestion of caustic liquid. No death occurred in the intra- and post-operation period. Cervical ileoesophageal anastomotic leaks took place in 2 cases as the early major postoperative complications, which healed spontaneously. Three cases of ileoesophageal anastomotic strictures were noted in the follow-up period. The surgical indications, the treatments of anastomotic leaks and strictures, and the importance of long-term follow-up were discussed.

Inflammation-induced Fos protein expression in the rat spinal cord is enhanced following dorsolateral or ventrolateral funiculus lesions

Previous studies have shown an enhanced expression of Fos protein-like immunoreactivity in the lumbar spinal cord of rats with complete spinal transection following persistent hindpaw inflammation. To further locate the spinal pathways responsible for these effects, we compared the inflammation-evoked Fos expression in rats with bilateral lesions of the dorsolateral (DLFX) or ventrolateral (VLFX) funiculus, and with rats with a sham operation. The results indicate that the number of Fos-labeled neurons was significantly increased in all laminae of the dorsal horn ipsilateral to the inflamed hindpaw and in contralateral deep dorsal horn in both DLFX and VLFX rats compared to sham-operated rats. Moreover, when comparing DLFX and VLFX rats, in the ipsilateral spinal cord, DLFX resulted in more Fos expression in the deep dorsal horn; in contrast, a larger number of Fos-labeled cells in superficial laminae was observed in VLFX rats. These results suggest that modulatory systems, which descend in both DLF and VLF pathways, mediate the enhanced net descending nociceptive inhibition after persistent inflammation, although the supraspinal sites of origin of each pathway are likely functionally diverse.

X-ray lens of monolithic polycapillaries for macromolecular crystallography

The monolithic polycapillary X-ray Lens is a fast developing optics that has many applications in different fields, one of them, described in this paper, is a successful application in the X-ray diffraction for macromolecular crystallography. The direct beam intensity irradiating on crystal with usage of the monolithic X-ray lens was increased 1 to 2 order of magnitude more than the traditional method with the double focusing mirrors. the diffracted X-ray intensity was increased more than about 8 times, the resolution was improved by 0.2–0.6Å, and the signal to noise ratio was also improved. The measuring time became shorter. The crystal samples which had to be analyzed by synchrotron before are able to be investigated in routine laboratory now.

[Determination of aniline derivatives in waste water with reversed-phase high performance liquid chromatography]

A reversed-phase high performance liquid chromatographic method for the determination of aniline derivatives in waste-water is described. Chromatographic conditions were: column, Hypersil BDS (200 mm x 4.0 mm i.d., 5 microm); mobile phase, methanol-water, gradient elution; flow rate, 1.0 mL/min; detection wavelength, 254 nm. Quantification was carried out based on the external standard of aniline derivatives. The pH of waste water sample was adjusted to 11-12 with dilute NaOH solution prior to extraction with CH2Cl2. The extractives concentrated in K-D concentrator and filtered with FH 0.5 microm membrane. Finally make up the volume to 1 mL and test it with reversed-phase high performance liquid chromatography. The linearity range of calibration curve used was 0.005-0.3 microg. The minimum detectable quantities of aniline derivatives varied from 1.20 ng to 3.00 ng. The average recoveries were from 51.57% to 107.92%, and the RSDs of the method were from 1.88% to 5.98%. The method is simple, rapid, and accurate.

Cell cycle-dependent colocalization of BARD1 and BRCA1 proteins in discrete nuclear domains

Germ-line mutations of the BRCA1 gene predispose women to early-onset breast and ovarian cancer by compromising the gene's presumptive function as a tumor suppressor. Although the biochemical properties of BRCA1 polypeptides are not understood, their expression pattern and subcellular localization suggest a role in cell-cycle regulation. When resting cells are induced to proliferate, the steady-state levels of BRCA1 increase in late G1 and reach a maximum during S phase. Moreover, in S phase cells, BRCA1 polypeptides are hyperphosphorylated and accumulate into discrete subnuclear foci termed "BRCA1 nuclear dots." BRCA1 associates in vivo with a structurally related protein termed BARD1. Here we show that the steady-state levels of BARD1, unlike those of BRCA1, remain relatively constant during cell cycle progression. However, immunostaining revealed that BARD1 resides within BRCA1 nuclear dots during S phase of the cell cycle, but not during the G1 phase. Nevertheless, BARD1 polypeptides are found exclusively in the nuclear fractions of both G1- and S-phase cells. Therefore, progression to S phase is accompanied by the aggregation of nuclear BARD1 polypeptides into BRCA1 nuclear dots. This cell cycle-dependent colocalization of BARD1 and BRCA1 indicates a role for BARD1 in BRCA1-mediated tumor suppression.

[Studies on the chemical constitutens of Vicia amoena Fisch]

One new flavonoide was isolated from Vicia amoena Fisch. On the basis of spectral (UV, MS, NMR) and chemical reactions, it was elucidated to be kaempferol-3-O-beta-D-mannoside, named amoenin(A3). Moreover, five known compounds have been isolated and identified as quercetin, kaempferol, quercetin-3-O-alpha-L-rhamoside, quercetin-3-O-beta-D-glucoside, kaempferol-3, 7-O-alpha-L-dirhamoside. The total flavonoides showed significant effects on inducing hyperlipidemia and increasing micro-blood vessel elasticity.

Cross-leg free flaps for difficult cases of leg defects: indications, pitfalls, and long-term results

BACKGROUND

Cross-leg free flaps have been described for reconstruction of leg defects in cases of trauma with no suitable recipient vessels in the vicinity of the defect. The pitfalls, however, have not been well documented in the literature. The technique of transfer and the length of time required before pedicle division depend on the nature of the flap and the contact surface.

METHODS

Eight cross-leg free flap reconstructions were performed on seven patients between 1986 and 1993. These included three latissimus dorsi muscle flaps, three fibula osteomyocutaneous flaps, one tensor fascia lata myocutaneous flap, and one posterolateral thigh flap. The important technical considerations are outlined.

RESULTS

One latissimus dorsi flap failed, whereas the rest of the flaps completely survived. The morbidity of the recipient and donor sites are listed.

CONCLUSION

We conclude that the technique offers the possibility of salvaging limbs that are, otherwise, nonreconstructable. It is useful for young patients. When the flap is long, it can function as a nutrient flap for the distal limb even though the pedicle has been divided. It is a backup procedure in an urgent situation of re-exploration in which reestablishment of circulation should take place as soon as possible.

St. Louis Integrated Immunization Information System

The immunization rate for St. Louis, Missouri, children age two and younger is only 49 percent, below the statewide rate of 64 percent and far below the estimated national rate of 75 percent. In response to this crisis, the St. Louis Integrated Immunization Information System (SLIIIS) was designed to establish an on-line immunization information system, identify barriers to immunization among health care providers and the client population, and implement methods for removing these barriers. Available to both public and private health care providers, SLIIIS uses a population-based approach to monitoring and improving immunization levels in the Eastern Missouri Region. SLIIIS was initiated by a partnership of an academic center with community agencies and institutions. Review of initial development efforts and system design may be valuable to others involved in creating regionally integrated information systems.

[An evaluation of the long-term results of palatopharyngeal closure function after velopharyngeal ring ligation]

16 cases were selected randomly from a group of 36 postoperative patients who underwent velopharyngeal ring ligation 16 years ago for evaluation of pronunciation, pharyngeal radiography, and electric endostroboskop to evaluate the patients' velopharygeal closure function. It was found that the pronunciation function of 93% patients were in good status. The results showed that centripetal force of velopharyngeal ring ligation made the velopharyngeal cavity reduced from the right to left and from anterior to posterior sides. It was good for sphincter of velopharyngeal moving, which could reduce the space of pharyngeal cavity and add the length of soft palate. The velopharyngeal closure was improved, which produced a good condition for the recovery of pronunciation function, at the same time, the change of pharyngeal cavity adapts to the patient's growth without limiting the growth and development of nasovelopharyngeal.

Sex hormone receptors of hemangiomas in children

OBJECTIVE

To investigate whether or not estrogen receptor and other sex hormone receptors are present in hemangioma tissues of children.

METHODS

Fifty-two specimens of hemangiomas were taken from 52 children. The specimens were doubly stained with hematoxylin-eosin and enzyme-linking affinity immunohistochemistry. The prepared tissue slides were observed under the microscope to search for estrogen receptors (ER), progestogen receptors (PR) and androgen receptors (AR) in all the cells.

RESULTS

ER, PR and AR were detected in various kinds of hemangiomas. The mean positive cell rate of each sex hormone receptor in different hemangioma tissues revealed no significant distinction in statistics (P > 0.05).

CONCLUSIONS

The results suggest that hemangiomas are one of the target tissues of estrogen. Estrogen, ER, PR, and AR may play an important role in the growth and development of hemangiomas.

[Study on relationship of soluble interleukin-2 receptors in serious hepatitis B patients and the T lymphocyte subgroup]

The assay of sIL-2R and T lymphocyte subgroup in 21 cases of serious HB patients revealed that serum sIL-2R in patients of acute and subacute or chronic serious HB was significantly higher than those in normal controls, P<0.001, but the CD4+ lymphocytes in all these patients obviously decreased and CD8+ lymphocytes notably increased when compared with that in normal group, P<0.01. The results showed that increasing of sIL-2R is associated with the activation of CD8+ cells which is mainly of cytotoxicity T lymphoeytes that play an important role in the pathogenesis of acute and subacute serious HB. The different expression of CD4+ and CD8+ in acute and chronic serious HB suggests a different pathogenetic mechanism between them.

A contribution of neurokinin-1 receptor to formalin-induced c-fos expression in the rat spinal dorsal horn

Formalin applied to a hindpaw of the rat resulted in c-fos expression in the spinal dorsal horn neurons on the ipsilateral side of stimulation. The role of neurokinin-1 (NK-1) receptor in this response was examined using a selective NK-1 antagonist L-668169. L-668169 administered intrathecally (1 microg/10 microl, 10 microg/10 microl) 15 min before injection of 2% formalin into one hindpaw significantly decreased the number of Fos-labeled neurons in the dorsal horn. A smaller dose of L-668169 (0.1 microg/10 microl) was ineffective. It was also showed that a selective NK-1 agonist Sar-SP perfused intrathecally (10 microg/10 microl) did result in the production of c-fos mainly in laminae I and that SP-like immunoreactive varicosities apposed neurons with Fos-labeled nuclei at their perikaryal membrane in the superficial laminae. These results indicate that NK-1 receptors may contribute to the activation of c-fos in the spinal dorsal horn neurons.

[Fetal fibronectin and preterm birth]

OBJECTIVE

To determine whether fetal fibronectin is a sensitive test for the diagnosis and prediction of preterm birth.

METHODS

Fetal fibronectin was measured by enzyme-labeled immunosorbent assay (ELISA) methods in sample of cervical secretion from 38 women with threatened preterm delivery (study group) and 43 normal pregnanty women with same gestational weeks (control group).

RESULTS

The positive rate of fetal fibronectin in women with threatened preterm birth was significantly higher than that in the normal control group.

CONCLUSION

Fetal fibronectin is an important marker. It can be used for diagnosis and prediction of preterm birth.

X-Ray Focusing Optics and Its Applications in XRMF and XRL

A brief review of the research on capillary x-ray focusing optics (the x-ray lens) at the X-Ray Optics Laboratory of the Institute of Low Energy Nuclear Physics at Beijing Normal University is presented. As a new tool for controlling powerful wide-bandwidth x-ray beams, the x-ray lens has very broad applications in both pure and applied sciences and in industry. Research toward developing such optics continues to grow in Russia, United States, and China. Some applications of x-ray lenses have also been developed. The preliminary results of theoretical and experimental studies on applications of x-ray lenses in x-ray microfluorescence and deep submicron lithography are quite encouraging. These achievements anticipate the appearance of a new generation of x-ray equipment.

[Chemical anatomy of the nociceptive transmission and modulation in the spinal dorsal horn]

The present study had been made to study the distribution and synaptic characteristics of primary afferent C fibers and the normal chemical architecture of some neurotransmitters in spinal dorsal horn. The changes of the neurotransmitters with acute nociceptive stimulation were measured quantitatively. We demonstrated the synaptic relationships among primary afferent C fibers, inhibitory interneurons and nociceptive dorsal horn neurons and discussed their function in nociceptive transmission and modulation. These results provide evidence that acute pain evolved co-release of substance P and glutamate from C-fiber terminals may constitute a driving force for secondary activation of ascending projection neurons or of internal GABAergic antinoceciptive system directly via their receptors in the dorsal horn of the spinal cord.

In vitro effect of hemodilution on activated clotting time and high-dose thrombin time during cardiopulmonary bypass

BACKGROUND

Extreme dilution of clotting factors, as may occur during pediatric or neonatal cardiopulmonary bypass, often leads to inadequate monitoring of anticoagulation with activated clotting time (ACT). In this study we postulate that the high-dose thrombin time (HiTT) is less influenced by extreme dilution of clotting factors because it stimulates clotting through the common pathway.

METHODS

Heparinized prebypass blood was obtained from 30 adult cardiac surgical patients and was diluted in a laboratory setting with saline solution to mimic the clinical clear prime solution (group I; n = 10), with saline solution containing similar heparin as in the prebypass blood (group II; n = 10), and with fresh frozen plasma to substitute clotting factors in the diluted blood (group III; n = 10). Blood was diluted to four different degrees: a control without dilution, 25%, 50%, and 75% dilution. The ACT and HiTT were measured and compared.

RESULTS

In group I, significant prolongation of ACT was observed in blood diluted to 75% as compared with the nondiluted blood (p < 0.01). In contrast, HiTT was not prolonged at any degree of dilution but reduced proportionally to dilution up to 75%, reflecting the concomitant reduction of heparin. In group II, ACT increased at 25% dilution (p < 0.01) whereas HiTT increased at 50% dilution (p < 0.01). In group III, no prolongation of ACT or HiTT was found in any degree of dilution. Furthermore, adding fibrinogen to the diluted blood (n = 4) did not cause ACT to recover at 75% dilution, suggesting that dilution of other factors in the early clotting cascade rather than fibrinogen alone increases ACT.

CONCLUSIONS

These results imply that when blood is extremely diluted during cardiopulmonary bypass with a clear prime without substituted clotting factors, HiTT is a better test than ACT for anticoagulation monitoring.

A regional integrated information system to assure maternal-child health services: a progress report

Priorities for improving the health of our nation include rebuilding the public health infrastructure through increasing assessment, policy development, and assurance capacities in our communities. Capacity building necessitates formalizing and strengthening public health practice linkages to achieve Year 2000 objectives. Determining progress in achieving objectives requires development of public health infrastructure surveillance and data system capabilities. The Tracking Center of Tracking and Outreach Program for St. Louis (TOPS), through unique collaboration among academic and practice partners, laid the foundation for a Regional Integrated Information System (RIIS) by developing a centralized maternal-child health data base for prenatal and pediatric care providers. The RIIS model provides an example of a capacity building system designed to provide public health surveillance, assessment, planning, and evaluation capabilities. Medical Subject Headings (MeSH): health information systems, prenatal care, immunization, maternal-child health care, public health surveillance.

Blockade of capsaicin-induced reduction of GABA-immunoreactivity by spantide in cat spinal superficial dorsal horn

In our previous study, perineural application of capsaicin not only produced release and depletion of substance P from primary nociceptive afferent terminals, but also reduced GABA immunoreactivity in the superficial dorsal horn. The aim of the present study was to determine whether the release of GABA is triggered by substance P released from primary nociceptive afferent terminals by capsaican. GABA and substance P immunoreactivity in the lumbar dorsal horn was examined in two groups: in the first group the tibial nerve was treated with 3% capsaicin, and in the second group the dorsal surface of the lumbar cord was infused with spantide (50 nM), a substance P receptor antagonist, before application of capsaicin to the tibial nerve. Following perineural treatment of capsaicin for 30 min, both the GABA-immunostaining density and the number of GABA immunoreactive neurons were reduced significantly in the ipsilateral laminae I-II at L5 through L7. GABA immunoreactivity was reduced by 54.12%, 44.46% and 31.0% in the medial, central and lateral parts of the ipsilateral laminae I-II at L7, respectively. With pre-application of spantide to the spinal cord, GABA immunoreactivity was reduced only to 14.4%, 16.4% and 10.16%, respectively, in the medial, central and lateral parts of laminae I-II at L7 and no reduction of GABA immunoreactive neurons was observed. Additionally, capsaicin-induced reduction of substance P immunoreactivity was partially blocked by spantide. These results suggest that capsaicin produces substance P release from primary nociceptive afferent terminals, and that substance P, in turn, activates the second-order GABAergic interneurons in the dorsal horn. The functional significance of capsaicin-induced activation of GABAergic neurons in modulation of spinal nociception is discussed.

Effect of TENS-like stimulation on C afferent-induced c-fos expression in the rat spinal cord

Transcutaneous electrical nerve stimulation (TENS) has been widely used to relieve pain. This study examined the effect of TENS-like stimulation on primary C afferent-induced c-fos expression in the rat spinal dorsal horn. Fos-like immunoreactivity (FLI) evoked by excitation of C fibres of the tibial nerve was found ipsilaterally in laminae I-VIII and X of the spinal cord. The greatest number of FLI neurones was located in the medial half of laminae I-II0 and V at L5. When TENS-like stimulation (100 Hz) was applied proximally to the same tibial nerve, the number of FLI neurones by C afferents was reduced remarkably in ipsilateral laminae I-II0 and IV-VII. The results suggest that TENS stimulation-induced reduction of c-fos expression may reflect an inhibition of spinal nociception.

Are PRO discharge screens associated with postdischarge adverse outcomes?

OBJECTIVE

We evaluate whether patient outcomes may be affected by possible errors in care at discharge as assessed by Peer Review Organizations (PROs).

DATA SOURCES/STUDY SETTING

The three data sources for the study were (1) the generic screen results of a 3 percent random sample of Medicare beneficiaries age 65 years or older who were admitted to California hospitals between 1 July 1987 and 30 June 1988 (n = 20,136 patients); (2) the 1987 and 1988 California Medicare Provided Analysis and Review (MEDPAR) data files; and (3) the American Hospital Association (AHA) 1988 Annual Survey of Hospitals.

STUDY DESIGN

Multivariate logistic regression analysis was used to evaluate the association between the results of generic discharge administered by the PROs and two patient outcomes: mortality and readmission within 30 days. The analysis was adjusted for other patient characteristics recorded on the uniform discharge abstract.

PRINCIPAL FINDINGS

Four discharge screens indicated an increased risk of an adverse outcome-absence of documentation of discharge planning, elevated temperature, abnormal pulse, and unaddressed abnormal test results at discharge. The other three discharge screens examined-abnormal blood pressure, IV fluids or drugs, and wound drainage before discharge-were unrelated to postdischarge adverse outcomes.

CONCLUSIONS

Generic discharge screens based on inadequate discharge planning, abnormal pulse, increased temperature, or unaddressed abnormal tests may be important indicators of substandard care. Other discharge screens apparently do not detect errors in care associated with major consequences for patients.

[A study of relation of cardiac function and deformity degree in children with pectus excavatum]

40 children with pectus excavatum were divided into subgroups according to the FI (> 0.2 or < 0.2) and underwent M-ME examination for their cardiac function. 28 of 40 patients had their cardiac function and thoracic index re-examined after the operation. The results showed the cardiac function of children with pectus excavatum was damaged as FI of the patients was less than 0.2 and their cardiac function was getting well as their thoracic index improved.

[Excision of mid-lower rectal carcinoma through abdomen and anogenital space]

28 men with male mid and lower rectal carcinoma were treated by dissecting sigmoid colon and rectum in the abdomen through the anogenital space, which refers to the potential coronoid space located between the deep transverse perineal muscles and anal sphincter muscles. The rectal segment was pulled out through the anogenital space to accomplish resection and anastomosis outside the pelvic cavity. Follow-up for 9-57 months showed that 26 cases (92.9%) survived without recurrence of carcinoma and 1 had local recurrence. The advantages of the procedure include clear exploration, minimal trauma, super-lower anastomoses under direct vision, good recovery of defecating function, and less contamination of pelviccavity.

Neurobehavioral effects of phenytoin and carbamazepine in patients recovering from brain trauma: a comparative study

OBJECTIVE

To compare the effects of prophylactic anticonvulsant use of phenytoin and carbamazepine on the cognitive and emotional status of the patient after brain injury.

DESIGN

Double-blind, placebo-controlled study with assessments before and after withdrawal from drug treatment.

SETTING

Patients had been initially treated by neurosurgeons at a university hospital and were followed up during the study on an outpatient basis.

PATIENTS

Forty of 64 patients receiving phenytoin and 42 of 127 patients receiving carbamazepine from 6 to 44 months for seizure prophylaxis after brain injury met study criteria and were assigned to continue or discontinue treatment. Groups were balanced for age, sex, race, weight, intelligence, type of injury, duration of therapy, and drug plasma concentration at screening.

INTERVENTION

A battery of neuropsychological tests was administered twice during a 4-week baseline period, at the end of a 4- to 5-week period of continued drug treatment or placebo, and after 4 weeks of not receiving medication.

MAIN OUTCOME MEASURES

Attention and concentration, psychomotor speed, memory, verbal fluency, and emotional state.

RESULTS

No significant differences were found in the performance of patients in medication and placebo groups for either drug at the end of the placebo phase. Patients in the combined groups showed significant improvement (P < .01) on several measures of motor and speeded performance following cessation of drug treatment. Multivariate analyses showed additional differences between phenytoin and carbamazepine and also suggested a significant practice effect on some measures used.

CONCLUSIONS

Both phenytoin and carbamazepine seem to have negative effects on cognitive performance, particularly on tasks with significant motor and speed components. Practice effects were noted and may account for much of the improvement when patients stopped taking the drugs. Overall effects of the drugs were small and of limited clinical significance, but differences among subjects were noted that may affect selection of a particular drug for the individual patient.