Experience with a clinical parasitological examination in a clonorchiasis focus in the Amur River region

The clinical manifestations of clonorchiasis were studied in 190 patients in the Amur River region. The severity of the disease correlated with the excretion rates of Clonorchis eggs. The peculiarity of the region is a rather low egg excretion; 66.8% of patients excreted as many as 100 eggs/g, 27.3%, up to 1000 eggs/g. Most examinees (94.3%) suffered from chronic gastroduodenitis and functional disorders of the biliary system.     

Evidence of absorptive hypercalciuria in tuberculosis patients

In patients with granulomatous diseases, disturbances in calcium metabolism have been described. The aim of the study was to evaluate alterations in calcium metabolism in patients with tuberculosis. Forty patients with tuberculosis (TB) were studied in a baseline state (calcium intake 1000 mg/day). Fourteen of these patients were also studied after restrictive calcium diet (400 mg/calcium/day) and after a load of oral calcium of 1000 mg. In all the studies, calcium and phosphorus were measured in serum and urine, and parathyroid hormone (PTH) in plasma. In addition, serum 25OHD and 1,25(OH)2D (calcitriol) levels were measured in the baseline state and after the restrictive diet. In the baseline state, 25OHD levels were lower and urinary calcium higher in TB patients than in the control group. No patients had hypercalcemia, but hypercalciuria was present in 10 patients (25%). The patients with tuberculosis were divided according to the presence or absence of hypercalciuria. In both groups, the 25OHD levels were lower than in controls. Hypercalciuric patients had lower plasma parathyroid hormone levels and higher serum calcitriol levels than the control group and the TB patients without hypercalciuria. Urinary calcium excretion after a calcium load was higher in TB patients with hypercalciuria than in controls. A positive correlation was found between the calcitriol levels and postcalcium load urinary calcium excretion in patients with calcium hyperabsorption. These data indicate that absorptive hypercalciuria is frequently observed in patients with TB and is possible due to inappropriately high serum calcitriol levels.     

Rheumatologic view of the rheumatoid foot

Rheumatoid arthritis is a common systemic disease that affects between 0.3% and 1.5% of the general population worldwide. In 1988, it was estimated by the National Arthritis Foundation that there were 4 to 6 million cases of rheumatoid arthritis in the United States. There is general agreement that the feet are a major source of pain and disability at some point in the course of the illness. The frequency of involvement of the feet among 1000 patients with rheumatoid arthritis studied by Vainio was 91% in females and 85% in males. The clinical features and pathogenesis of the rheumatoid foot and an approach to initial nonsurgical treatment will be discussed.     

Risk factors for falls of hospitalized stroke patients

BACKGROUND AND PURPOSE: Patients with stroke are at a high risk for falling. We assessed the fall incidence and risk factors for patients hospitalized as the result of an acute stroke. METHODS: We studied a cohort of 720 stroke patients from 23 hospitals in The Netherlands. The data were abstracted from the medical and nursing records. RESULTS: We studied 346 women and 374 men with a median age of 75 years; 77% of the patients had had a cerebral infarct, 17% had had a hemorrhage, and 6% had had an undefined stroke. We recorded 104 patients (14%) who fell at least once; there were a total of 173 falls. The incidence of falls was 8.9/1000 patients per day. The daily incidence was 6.2/1000 patients for first falls and 17.9/1000 patients for second falls. Heart disease (relative risk [RR], 1.6; 95% confidence interval [CI], 1.0 to 2.4), mental decline (RR, 1.6; 95% CI, 1.0 to 2.4), and urinary incontinence (RR, 2.3; 95% CI, 1.3 to 4.1) were incremental risk factors for first falls, whereas the use of major psychotropic drugs lowered the fall risk (RR, 0.5; 95% CI, 0.3 to 0.8). The fall RR for patients with one previous fall was 2.2 (95% CI, 1.5 to 3.2), adjusted for the other risk factors. Most falls occurred during the day. Approximately 25% of the falls caused slight-to-severe injury, whereas three falls (2%) led to hip fractures. CONCLUSIONS: Stroke patients have at risk of falling. The identification of patients at risk may be a first step toward the implementation of fall-prevention measures for these patients.     

Generation of chromosome fragment specific bovine DNA sequences by microdissection and DOP-PCR

Trends in causative organisms and sources of infection were studied in a series of 288 episodes of bacteremia in neutropenic cancer patients observed in a single institution from 1986 to 1993. The incidence of bacteremia increased significantly from 20 episodes per 1000 admissions in 1986 to 50 episodes per 1000 admissions in 1993 (p = 0.00001). Over the study period, a continuous increment in gram-positive bacteremia, which reached 81% of episodes in 1993 (p = 0.000001), was observed. Conversely, the incidence of gram-negative bacteremia remained stable. Coagulase-negative staphylococci and viridans group streptococci were the most commonly isolated pathogens. Bacteremia caused by coagulase-negative staphylococci increased from 3 episodes per 1000 admissions to 19 episodes per 1000 admissions (p = 0.0001), and viridans group streptococci bacteremia increased from 0 episodes per 1000 admissions to 19 episodes per 1000 admissions (p = 0.000001). The upward trend in gram-positive bacteremia appeared to be related to a significant increase in both intravascular catheters (p = 0.003) and oral mucositis (p = 0.003) as sources of infection. Specific strategies to prevent chemotherapy-induced mucositis and catheter-related bacteremia merit further investigations.     

The additive effects of glucose and insulin on the proliferation of infragenicular vascular smooth muscle cells

PURPOSE: Peripheral vascular disease involving the infragenicular arterial tree is common in patients with diabetes mellitus (DM). Accelerated proliferation of vascular smooth muscle cells (VSMCs) plays an important role in the development of atherosclerosis. Insulin and glucose stimulate VSMC proliferation and are elevated in patients with non-insulin-dependent DM. We have previously described the mitogenic effect of insulin on VSMCs in vitro; the effects of insulin and glucose separately and in combination on the proliferation of VSMCs grown in serum-free media were studied. METHODS: Human infragenicular VSMCs isolated from diabetic patients with end-stage peripheral vascular disease undergoing below-knee amputation were used. Cells from passages 3 to 5 were grown in serum-free media with varying glucose (0.05%, 0.1%, 0.2%, 0.4%, 0.6%, and 0.8%) and insulin (no added insulin, 100 ng/mL, and 1000 ng/mL) concentrations for 6 days. RESULTS: Insulin stimulated VSMC growth at glucose concentrations more than 0.2% (0.4% glucose with no added insulin resulted in 13,073 +/- 336 cells/mL, 0.4% glucose with 100 ng/mL insulin resulted in 16,536 +/- 1175 cells/mL, 0.4% glucose with 1000 ng/mL insulin resulted in 17,500 +/- 808 cells/mL, 0.6% glucose with no added insulin resulted in 14,167 +/- 1062 cells/mL, 0.6% glucose with 100 ng/mL insulin resulted in 18,984 +/- 1265 cells/mL, 0.6% glucose with 1000 ng/mL insulin resulted in 20,450 +/- 1523 cells/mL, 0.8% glucose with no added insulin resulted in 15, 853 +/- 1650 cells/mL, 0.8% glucose with 1000 ng/mL insulin resulted in 26,302 +/- 1919 cells/mL; P <.05 compared with glucose with no added insulin). Glucose stimulated VSMC proliferation up to a concentration of 0.2% (42% and 117% higher growth at 0.1% and 0.2% glucose, respectively, compared with the baseline, P <.05), regardless of the insulin concentration in the media. The greatest growth (26,302 +/- 1919 cells/mL) occurred in the group with the highest concentration of both insulin (1000 ng/mL) and glucose (0.8% glucose; P <.05). CONCLUSION: Both insulin and glucose stimulate the growth of diabetic infragenicular VSMCs. The mitogenic effects of insulin and glucose are additive and may contribute to the development of atherosclerosis in patients with DM.     

Changes in erythroblast morphology as an index of response to cyanocobalamin in patients with megaloblastic anaemia

Fifty-three patients with megaloblastic anaemia treated with cyanocobalamin and folic acid have been studied. Repeat marrow examination was found to be of value in assessing response to treatment. The early improvement in marrow morphology in patients with pernicious anaemia was greater with 1000 mug than with 5 mug doses of cyanocobalamin. The effect of folate deficiency in delaying marrow response to cyanocobalamin in patients with pernicious anaemia is described and combined cyanocobalamin and folic acid treatment was found to be more effective than either alone. The response to large doses of cyanocobalamin in folate deficient patients was unrelated to the initial serum vitamin B12 level.     

Recombinant granulocyte colony-stimulating factor in the long-term treatment of AIDS-related neutropenias

Neutropenia is a common finding in patients with AIDS or AIDS-related complex (ARC), and limits their survival and therapies. We administered recombinant human granulocyte colony-stimulating factor (rG-CSF) 300 micrograms/day to 15 AIDS patients with severe neutropenia (< 1000/microliters). without discontinuing zidovudine, ganciclovir or other myelosuppressive drugs (e.g. antineoplastic chemotherapy). All patients showed correction of neutropenia and/or limitation of drug myelosuppressive action. Neutrophil count was > 1000/microliters during the whole follow-up (11 months). No patient showed sepsis, opportunistic infections or side effects. These data confirm the efficacy and tolerability of rG-CSF in AIDS-related neutropenia.     

固溶处理温度对D667钢性能的影响

研究了固溶温度对D667钢性能的影响。结果表明,D667钢固溶温度在1000℃以下时,其延伸率有所提高,但抗拉强度没有明显下降;固溶温度在1000℃～1060℃范围内,试验钢的抗拉强度呈下降趋势,延伸率也保持在高水平线上;固溶温度在1060℃以上,抗拉强度加速下降。D667钢固溶温度在1000℃～1060℃范围内时,可以获得较好的强度和韧性,满足技术要求和各项使用要求。     

Angiotensin-converting enzyme inhibitor in the treatment of epirubicin-induced dilated cardiomyopathy

Anthracycline chemotherapy of cancer can cause severe, frequently fatal congestive heart failure (CHF), the first line treatment for which is diuretics and digoxin. We have studied the use of an ACE-inhibitor added as a third agent. Of 85 patients evaluable for cardiotoxicity after treatment with a median of 1000 mg/m2 of epirubicin for metastatic breast cancer, nine developed CHF at 1.5 to 13 months after therapy. Left ventricular ejection fraction decreased from normal to 18 to 35%. All patients received digitalo-diuretic therapy and after a transient clinical relief enalapril or ramipril increasing from 1.25 mg orally daily to 10-15 mg after 4-6 weeks. Eight of the nine patients deteriorated while on digitalo-diuretic therapy. Within three months of starting the ACE-inhibitor in these patients, LVEF increased to normal or near normal. Only one patient died in heart failure. Follow-up ranged from 11-42 months (median 26) and survival in the nine patients was similar to that of those who did not develop CHF. We suggest that treatment of anthracycline-induced CHF with an ACE-inhibitor should start within one to two weeks after digitalo-diuretic therapy regardless of the severity of symptoms rather than waiting for clinical deterioration.     

Efficiency of computed tomography in diagnosis of silicotuberculosis

Seventy-five newborns from multiple pregnancies with very low and extremely low birth weight are studied. 94% of the infants under 1000 g and 66% of those above 1000 g are born by vaginal way. Intrapartal asphyxia develop most often the second twins with birth weight under 1000 g--64.7%. These are the infants with higher morbidity: RDS--56.5%, IVH--100%. The survival rate of the twins of this group is notably lower than that of the infants from singleton pregnancies with equal weight and gestational age: 12.1% under 1000 g and 69% above 1000 g, against 38.3% and 77.9% respectively.     

Clinical evaluation of the HeartPak. A new pneumatic portable driver for use with the HeartMate Implantable Pneumatic Left Ventricular Assist System

The HeartPak Portable Pneumatic Driver was designed for use with the HeartMate Implantable Pneumatic Left Ventricular Assist Device (IP-LVAS) (Thermo Cardiosystems, Inc., Woburn, MA). The HeartPak measures 48 x 23 x 15 cm, weighs 9.3 kg with batteries, and can be carried by a handle, by a shoulder strap, or on a trolley. Four 12 V batteries provide power for as long as 8 hr. To test the HeartPak in the hospital environment, seven men were studied who were bridge-to-transplant patients (mean age, 59.8 +/- 8.87 years) undergoing HeartMate IP-LVAS therapy. They were supported by the HeartPak for 429 days with a cycle count of 57,826,560. To normalize the mean pump flow rate, we used the body surface area to obtain a pump flow index in each case. The mean flow rate was 2.65 +/- 0.57 L/min/m2 for the HeartPak vs. 2.64 +/- 0.45 L/min/m2 for the HeartMate 1000, the conventional driver previously used in these patients. The only potentially serious problem with the HeartPak was console failure in one case. The patient took appropriate backup measures, and the HeartPak was replaced. In no case did the device cause any adverse effects or interruption of LVAS support. Compared with HeartMate 1000, the HeartPak was more convenient, easier to operate, and allowed better patient mobility.     

Induction of Fos immunoreactivity in the brain by exposure to the elevated plus-maze

The log-rank test is commonly used to assess therapeutic effect in prospective, randomised clinical trials. This test is sensitive to differences in survival between treatment groups at a specific endpoint, but cannot determine whether such a difference is due to an enhanced cure rate or an enhanced survival time among uncured patients. To investigate the clinical impact of such limitations, an algorithm was constructed to simulate clinical, randomised, adjuvant therapy trials in patients with a cured fraction of 0.27 and a median survival time for uncured patients of 3.4 years. Hypothetical therapies were introduced to increase rate of cure, increase median survival time, or achieve a combination of these effects. For 500 simulated patients recruited over a 5 year period and then followed for three additional years, a 50% enhancement of median survival time (to 5.1 years) led to a survival increase detectable at the P = 0.05 level in 780 of 1000 trials, whereas a 50% enhancement of cured fraction (to 40.5%) led to a detectable increase at the same level in only 449 of 1000 trials. These findings suggest that, in clinical trials of adjuvant therapy for stage 2 breast cancer, the log rank test may be more sensitive to increases in tumour-related survival time than to increases in cured fraction.     

Degradation of rail-steel structure and properties of the surface layer

The change in the structure–phase states and defect substructure of the rail surface after prolonged operation (passed tonnage of 500 and 1000 million t) is studied by optical microscopy, by scanning and transmission electron diffraction microscopy, and by measurement of the microhardness and tribological characteristics. It is found that the wear rate increases by a factor of 3.0 and 3.4 after passed tonnage of 500 and 1000 million t, respectively, while the frictional coefficient is reduced by a factor of 1.4 and 1.1, respectively. After 500 million t, the cementite plates break down completely, and rounded cementite particles (10–50 nm) are formed. After 1000 million t, the initial stage of dynamic recrystallization is noted. Possible explanations of the observations are discussed. Two competing processes may occur in rail operation: (1) fragmentation of the cementite particles, with their subsequent entrainment in the ferrite grains or plates (in the pearlite structure); (2) fragmentation and subsequent solution of the cementite particles, with transfer of the carbon particles to dislocations (Cottrell atmospheres) and transportation of carbon atoms by dislocations within the ferrite grains (or plates), culminating in the formation of cementite nanoparticles.     

Principles and value of isokinetic evaluation in ruptures of the anterior cruciate ligament

Isokinetic muscular evaluation allows to appreciate the knee joint functional patterns in conditions close to sports activities. Analyzing bilateral symmetry and agonist/antagonist ratios of the lower extremity, this method is a useful index for the objective evaluation of ligament-deficient knees. 106 patients with a chronic ACL deficient knee sustained a presurgery isokinetic evaluation. 94 patients had a post-operative evaluation and 13 a pre and post-surgery evaluation. All patients were simultaneously evaluated by clinical examination and measures of instrumental knee laxity (KT 1000). Results showed that isokinetic performance was not correlated to the objective laxity as measured with the KT 1000 but was correlated to 1) the type of laxity (i.e. associated postero-lateral laxity), 2) the functional level of activity, and 3) the time of disability. Best functional results were obtained in patients whose injured knee hamstring/quadriceps (H/Q) ratio was close to the uninjured knee H/Q ratio. The mean quadriceps deficit was over 15 per cent for 75 per cent of the patients one year after surgery, and for 50 per cent of the patients after two years. The quadriceps deficit was not parallel to the length of the autograft taken from the extensor mechanism. Isokinetic evaluation is a guideline for rehabilitation allowing specific strengthening of the weaker muscular groups.     

Fracture incidence in England and Wales: a study based on the population of Cardiff

Despite the importance of fractures as an economic and health problem, and consequent interest in osteoporosis, few workers have previously attempted to define the overall incidence of fracture. This population based study was based in the Accident and Emergency Department of Cardiff Royal Infirmary and identified all patients presenting with fractures of any type. Over a single year a total of 6467 fractures were identified among the 306,600 people who live in the city of Cardiff. This gives an overall fracture incidence of 21.1/1000/year, (23.5/1000/year in males and 18.8/1000/year in females); a result very similar to those from similar work in the USA, Australia and Norway. This result is over twice the previous estimate of fracture incidence in the UK; the figure of 9/1000/year from the only equivalent study performed since the 1960s. In part, this discrepancy appears to reflect our more rigorous definition of the study population, and our improved ascertainment of minor fractures. We believe our result to offer the most accurate estimate of fracture incidence currently available for a UK population.     

The effect of phosphorus on the ductility of 9Cr-1Mo steels

The ductile fracture characteristics of three special casts of 9Cr-1Mo steel with different phosphorus contents have been studied using plain tensile, notched tensile and Charpy impact specimens. A commercial cast of this steel has also been investigated for comparative purposes. The materials have been tested in the normalised and tempered condition and after ageing at 550°C for 1000 h and 5000 h. The results show that the ductility, DBTT and upper shelf energy (USE) of the low phosphorus material is unaffected by the 1000 h age, in contrast to the higher phosphorus casts which experience a deterioration in these properties. All the materials exhibit a deterioration in these properties after the 5000 h ageing treatment. The results support the view that the decrease in ductility associated with the 1000 h age in the higher P materials is caused by the segregation of phosphorus to the carbide/matrix interfaces and that the decrease in USE also arises from this source. The decrease in ductility and USE and the increase in DBTT after long term ageing is associated principally with the precipitation of Laves phase. Each material exhibits a decrease in ductility with increasing stress triaxiality and it is shown that a contribution to this effect may arise from the dependence of void nucleation on stress state.     

A survey of dermatophytosis in animals in Madras, India

The mechanism of postoperative hyperamylasaemia was studied in 48 patients undergoing coronary artery bypass grafting (CABG). Mild hyperamylasaemia developed in 87% of the patients, and in 10% the serum amylase activity was > 1000 U/l. Serial measurements of serum salivary (S-) and pancreatic (P-) isoamylases indicated that hyperamylasaemia was highest 24 hours after CABG and consisted mainly of P-amylase component. Serum creatinine, creatinine clearance and urinary albumin concentration remained normal after CABG, excluding severe renal damage. The fractional clearance (i.e. relative to creatinine clearance) of P-amylase decreased more than of S-amylase (from 3.6 to 0.9% vs 1.3 to 0.8%). Decreased rate of excretion into urine, rather than pancreatic cellular damage, is the main source of hyperamylasaemia after CABG.     

Effect of early postoperative enteral nutrition on postoperative infections

We undertook this study to test the hypothesis that early enteral nutrition might reduce the incidence of serious complications after major abdominal surgery. In a randomized double blind prospective trial 30 patients received Nutridrink and 30 patients received placebo through a nasoduodenal feeding tube. On the day of operation the patients were given median 600 ml nutrition/placebo, 60 ml/h. On the first postoperative day the patients received median 1000 ml nutrition/placebo, second day median 1200 ml nutrition, 1400 ml placebo, third postoperative day median 1000 ml nutrition, 1150 ml placebo and 4th postoperative day median 1000 ml nutrition, 800 ml placebo. All patients were followed for 30 days by the same investigator. The two groups were not different with regard to nutritional status and type of operation. The rate of postoperative infectious complications was significantly lower in the nutrition group, 2/30 compared to 14/30 in the placebo group (p = 0.0009). We conclude that early enteral nutrition given to patients after major abdominal surgery is followed by a major reduction in infectious complications.     

Bone density changes in postmenopausal women with the administration of ipriflavone alone or in association with low-dose ERT

BACKGROUND: Reports suggest that antituberculosis drugs are malabsorbed in patients with advanced HIV disease. OBJECTIVE: To evaluate the pharmacokinetics of antituberculosis agents in HIV-seropositive patients at different stages of disease. DESIGN: Parallel study. SETTING: Two hospital outpatient clinics. PARTICIPANTS: 12 healthy volunteers, 12 patients with asymptomatic HIV disease, 12 patients with symptomatic HIV disease, and 12 patients with symptomatic HIV disease and diarrhea. MEASUREMENTS: Drug plasma concentrations were measured over 24 hours on day 4 of concurrent therapy. INTERVENTION: Oral isoniazid (300 mg/d), rifampin (600 mg/d), pyrazinamide (1000 mg/d), and ethambutol (1000 mg/d). RESULTS: Reduced total drug exposure to rifampin and pyrazinamide was associated with D-xylose malabsorption in persons with HIV infection or AIDS. Peak drug exposure to isoniazid was lower in patients with diarrhea. CONCLUSIONS: Reduced total drug exposure may be related to malabsorption in persons with HIV infection or AIDS.