The ''dropping'' and ''hornblower''s'' signs in evaluation of rotator-cuff tears

Both decreased and increased perfusion and metabolism have been described with PET and SPECT in different areas of the brain in patients with Gilles de la Tourette's syndrome. The aim of this study was to define the regional cerebral perfusion pattern in drug-free patients and the changes in perfusion with the usual neuroleptic treatment. METHODS: A group of 13 normal control subjects and 15 unmedicated Gilles de la Tourette's syndrome patients were studied with 99mTc-HMPAO brain SPECT. Thirteen of the initial group of patients were retested on neuroleptic treatment. A semiquantitative analysis of the images was performed. RESULTS: Decreased perfusion in orbital and anterior medial regions of both frontal lobes as well as in both temporal lobes was observed in the nontreated group compared with control subjects. With treatment, a perfusion increase in these frontal regions and in the left medial temporal cortex was observed. CONCLUSION: Neuroleptic treatment could decrease the hyperactivity of the dopaminergic system leading to improvement of the clinical symptoms and reperfusion of some previously hypoperfused regions.     

The fatty liver: pitfalls of the CT and angiographic evaluation of metastatic disease

Five patients with known primary malignancy demonstrated fatty infiltration of the liver on routine computed tomography (CT) examination. Within the diffuse fatty infiltration were focal areas of relatively increased beam attenuation in four cases. These areas of increased beam attenuation are nonspecific as to etiology. Their differential diagnosis is discussed. Since the true extent of the neoplastic process may be underestimated by conventional CT and celiac angiography, superselective angiography, computed angiotomography, or biopsy is required to accurately assess the etiology and the extent of the disease.     

Interobserver variation in the evaluation of neurological signs: observer dependent factors

We have previously reported that polymorphonuclear granulocyte (PMN) and monocyte oxidative metabolism is reduced in polycythemia vera (PV) patients compared to healthy control subjects, after stimulation with cell surface receptor-dependent stimuli such as n-formyl-methionyl-leucyl-phenylalanine, leukotriene B4 and platelet-activating factor (PAF). In contrast, the oxidative response to phorbol myristate acetate (PMA) is normal. We now show that, in PV patients exhibiting significantly reduced PMN chemiluminescence after PAF stimulation, PAF induced platelet aggregation was also reduced--40 +/- 3% compared to 50 +/- 2% in controls (p < 0.01). The defective aggregatory response to PAF in PV remained over a wide range of stimuli concentrations. Platelet aggregation induced by PMA and ADP, however, was similar in PV and controls. In contrast, platelet aggregation induced by PAF (or by ADP and PMA) was not significantly reduced in patients with chronic myeloid leukemia, essential thrombocythemia and multiple myeloma. Furthermore, the release of beta-thromboglobulin was slightly but not significantly higher after PAF stimulation in PV and this argues against an abnormal PAF receptor as the cause of the defective function. Thus, not only PV neutrophils, but also PV platelets show a discrete defect of the stimulus response coupling for PAF, indicating a disease-specific abnormality that appears to be of clonal origin.     

Follow-up of TIPS: evaluation of signs of dysfunction with Doppler ultrasonography

The anemia of malignancy is common and is related to several etiologic factors, a major one being relative erythropoietin (Epo) deficiency. Blood transfusions, the traditional therapy, provides a quick solution but is associated with complications. This was the rationale for recombinant human Epo (rHuEpo) in the treatment of anemia of cancer. Over the past few years, about 20 publications have reported the results of rHuEpo in the treatment of cancer-associated anemia in more than 850 patients with a variety of malignancies. In general, more than half of the patients responded with a significant increase in their hemoglobin level, a decrease in blood transfusion requirements, and an improved performance status and quality of life. About 4 weeks are required till the onset of effect. The hormone is well tolerated with minimal adverse effects and subcutaneous injections appear to be the preferred method of administration. Additional studies will hopefully answer several questions including optimal dosage and duration of treatment, Epo resistance, and the possibility of predicting the response.     

Experimental evaluation of various anchoring techniques for synthetic ligaments

One of the weak points of augmentation or replacement of cruciate ligaments by synthetic material is the fixation of these artificial ligaments to the bone. The present investigation examines the mechanical properties of a newly developed anchoring technique (ligament fixation device = LFD) in regard to linear and maximum load, stiffness, creep, and long-term durability compared to single staples, double staples in belt buckle technique, and passing the ligament through an additional bone tunnel. The tests are carried out on cadaver knees and plastic bones under standardized conditions with the same artificial ligament in all experiments (Trevira hochfest). The LFD shows a linear load of 1866 N in cadaver knees and 1874 N in plastic bones. The stiffness is 68.3 N/mm respectively 51.9 N/mm, the elongation at 500 N load 12.7 mm respectively 10.9 mm. In the hysteresis tests with submaximum loads the ligament/LFD-unit lasts 8515 cycles in the plastic bone and 4431 cycles in the cadaver knee. These results are significantly superior to all other fixation techniques concerning linear load, stiffness and long-term durability. They permit aggressive functional treatment and immediate postoperative weight bearing of the operated knee.     

中国城市社区居民满意度评价体系的构建

结合主成分分析法和层次分析法(AHP)给出一种合理的中国城市社区居民满意度评价指标体系构建方法.首先选取大连市5种类型社区467位居民为样本,对众多影响社区居民满意度的因素进行分类,得出三级指标,并利用主成分分析法提取少数几个关键因子作为二级指标,再运用AHP 和专家调查法确定各因素在每一层级中的权重,最终获取城市社区居民满意度评价体系.     

Prospective evaluation of the gastrointestinal tract in patients with iron deficiency and no systemic or gastrointestinal symptoms or signs

BACKGROUND: Although endoscopic evaluation of the gastrointestinal tract is commonly performed to evaluate iron deficiency, little data is available regarding the underlying causes, yield of evaluation, and long-term outcome for those in whom gastrointestinal and systemic symptoms and signs are absent. METHODS: In- or out-patients seen by the gastroenterology consultative service at a large inner-city hospital over a 56-month period were considered eligible for the study when iron deficiency (serum ferritin <50 ng/mL) was documented. Exclusion criteria included: any gastrointestinal or systemic symptoms/signs, radiographic or endoscopic examinations of the gastrointestinal tract within 3 and 5 years, respectively, or obvious source of blood loss. Patients underwent colonoscopy and if no lesions other than carcinoma were found, upper endoscopy was then performed with a pediatric colonoscope. RESULTS: Fifty-two patients were evaluated (mean age, 66 +/- 13 years; range, 20 to 89 years; 32 men/20 women). At the time of evaluation, the mean (+/-SD) hematocrit was 25% +/- 7% (range, 14% to 42%). Overall, 23 patients (44%; 95% CI 30% to 59%) had an identifiable gastrointestinal lesion considered the cause of iron deficiency, including: colonic carcinoma, 11 (21%); colonic and/or esophagogastric/duodenal vascular ectasias, 9 (17%); and gastric carcinoma, colonic polyposis, and colonic ulcers in 1 patient each. Long-term follow-up (median 24 months, range 2 to 63 months) identified only 1 patient with a cause found (colonic carcinoma), and in this patient, complete colonoscopy was not technically possible at the time of initial evaluation. There were no clinical or laboratory features that distinguished patients with an etiology for iron deficiency to the idiopathic group. CONCLUSIONS: Approximately half of patients with iron deficiency in whom gastrointestinal or systemic signs or symptoms are absent have an underlying gastrointestinal lesion. Nevertheless, despite a thorough endoscopic evaluation, some patients will have no etiology found; the prognosis for these patients is excellent.     

用可持续发展度来预测评价通化地区的钢铁工业

根据有关政策、法规和通化地区生态环境及经济结构等因素,选择5类4层24项指标,构成通化地区可持续发展度指标体系.采用专家评分方法,建立层次加权组合法的多指标综合测算模型,预测评价通化地区钢铁工业对生态环境和社会经济的影响,并对2010年和2020年通化地区可持续发展度给出了定量评价,验证各项指标的合理性.     

Economic evaluation of various hepatitis B vaccination strategies in children and adolescents

AIM: In this cost-effectiveness study 4 different vaccination strategies against hepatitis B in children and adolescents are evaluated and compared with the situation without immunization. EXAMINATION: Projections are made for the population of the today's adolescents underage 15 and the newborns of the next 30 years. The number of avoided hepatitis B virus (HBV) infections and the cases of disease as well as the costs associated with treatment and vaccination are determined. The course of incidence of the hepatitis B virus is observed for different age groups. RESULTS: Compared to the situation without any vaccination against hepatitis B, a decrease of the remaining infections of at least 18,900 up to 46,600 could be expected during the next 30 years. The treatment costs for the remaining cases of disease could be reduced by 0.4 up to 1.6 billions DM. The remaining expenditures for treatment and vaccination would be limited to 2.3 up to 3.4 billions DM. The net costs of a vaccination are determined as about 14,200 up to 63,000 DM per avoided case of infection. Considering the commonly accepted number of unreported cases of hepatitis B as to be the 5- to 10 fold of the known incidence, all of the 4 compared vaccination strategies will be cost-effective and associated with net savings of about 5,900 up to 36,400 DM per avoided case of hepatitis B virus infection during 30 years. The epidemiological situation will be positive influenced by such a mass vaccination. The minimization of incidence is shown for the different age groups. CONCLUSION: Considering these economical arguments, first the vaccination of all adolescents between age 11 to 15 and second the vaccination of all children/adolescents between age 0 to 15 are the preferable strategies. The immunization of all children/adolescents between age 0 to 15 is the most effective strategy from an epidemiological point of view.     

Biomechanical regularities in the distribution of tension in various topographic zones of the eyelids in children in health and myopia of different degree

The authors assessed the method for life-time study of the biomechanical characteristics of ocular tissues in 281 children (562 eyes) aged 7 to 14 years. The method for assessing the biomechanics of the eyelids is described. In detail. The rates of propagation of acoustic waves in normal tissue and in 1.0 to 6.0 diopters myopia are presented. A correlation has been revealed between the increase of the velocity of acoustic surface waves, propagating in the horizontal direction in the internal segment of the orbital area of the upper eyelids, and the value of clinical refraction in myopia. The authors consider clinical signs of myopia-screwing up one's eyes and a wider lid slit-from a biomechanical viewpoint.     

Changes in the degree of sialylation of carbohydrate chains modify the biological properties of circulating thyrotropin isoforms in various physiological and pathological states

Variation in asparagine-linked carbohydrate chains have a major impact on TSH biological properties. In particular, highly sialylated TSH is characterized by impaired intrinsic bioactivity and prolonged half-life. The aim of the present study was to investigate the changes in the degree of sialylation of circulating TSH isoforms that may occur in several physiological and clinical situations. Bioactivity and terminal sugar residues of immunopurified TSH were studied in 26 normal adults (day- and nighttime serum pools), 2 cord serum pools from normal fetuses during the third trimester, 1 fetus with primary hypothyroidism (PH; 27th week), 1 fetus with resistance to thyroid hormone (RTH; 28th and 33rd weeks), 24 patients with PH (before and during L-T4 treatment), and 5 patients with RTH before and during triiodothyrocetic acid (TRIAC) treatment. Nighttime TSH isoforms have an increased degree of sialylation compared to daytime TSH (35.8 +/- 9.7% vs. 23.8 +/- 5.8%; P < 0.03), thus accounting for the lower bioactivity [biological/immunological TSH ratio (TSH B/I), 1.3 +/- 0.4 vs. 2.0 +/- 0.2; P < 0.0007]. In adult PH, TSH isoforms are highly sialylated (45.4 +/- 7.6%; P < 0.007), showing an impaired bioactivity (0.7 +/- 0.3; P < 0.001). L-T4 therapy was accompanied by a trend toward normalization of TSH biological properties; TSH B/I was higher (1.0 +/- 0.3; P < 0.01), and the degree of sialylation was lower (36.8 +/- 7.0%; P < 0.02). A significant inverse correlation between TSH B/I values and the degree of sialylation was observed (P < 0.001). In normal fetuses, extremely bioactive asialo-TSH isoforms are circulating during the 3rd trimester. The impaired thyroid hormone action, such as that occurring in hypothyroid or RTH fetuses, induces an early expression of alpha-2,6-sialyltransferase activity within thyrotropes and results in the secretion of high amounts of sialylated TSH isoforms (34.6% and 26.3%). A hybrid TSH with peculiar terminal sugar residues and enhanced bioactivity is circulating in patients with RTH (TSH B/I, > or = 2.2). Treatment with low doses of TRIAC can initially reduce thyroid hormone secretion in RTH, mainly through the secretion of TSH isoforms with changed terminal sugar residues and reduced bioactivity (TSH B/I, 0.9-1.7). In conclusion, changes in the terminal sialic acid residues modulate the biological properties of circulating TSH, play a relevant physiopathological role in various situations, and contribute to adjust thyroid-stimulating activity to temporary needs.