Racial and Ethnic Disparities in the Management of Chronic Coronary Disease

Chronic coronary disease (CCD) comprises a continuum of conditions that include obstructive and non-obstructive coronary artery disease with or without prior acute coronary syndrome. Racial and ethnic representation disparities are pervasive in CCD guideline-informing clinical trials and evidence-based management. These disparities manifest across the entire spectrum of CCD management, spanning from non-pharmacological lifestyle changes to guideline-directed medical therapy, and cardiac rehabilitation to invasive procedures. Recognizing and addressing the historical factors underlying these disparities is crucial for enhancing the quality and equity of CCD management within an increasingly diverse population.

The Use of Dynamic Navigation Systems as a Component of Digital Dentistry

The development of dynamic navigation system (DNS) has facilitated the development of modern digital medicine. In the field of dentistry, the cutting-edge technology is garnering widespread recognition. Based on the principles of 3-dimensional visualization, virtual design, and precise motion tracking, DNS is mainly composed of a computer, a tracking system, specialized tracer instruments, and navigation software. DNS employs a workflow that begins with preoperative data acquisition and imaging data reconstruction, followed by surgical instrument calibration and spatial registration, culminating in real-time guided operations. Currently, the system has been applied in a broad spectrum of dental procedures, encompassing dental implants, oral and maxillofacial surgery (such as tooth extraction, the treatment of maxillofacial fractures, tumors, and foreign bodies, orthognathic surgery, and temporomandibular joint ankylosis surgery), intraosseous anesthesia, and endodontic treatment (including root canal therapy and endodontic surgery). These applications benefit from its enhancements in direct visualization, treatment precision, efficiency, safety, and procedural adaptability. However, the adoption of DNS is not without substantial upfront costs, required comprehensive training, additional preparatory time, and increased radiation exposure. Despite challenges, the ongoing advancements in DNS are poised to broaden its utility and substantially strengthen digital dentistry.

[An endoscopic-assisted technique for the enlarged middle cranial fossa approach to the petroclival region: an anatomic study]

Objective:Through the observation and measurement of the adjacent anatomical structures exposed by the pure microscope and endoscopic-assisted technique for the enlarged middle cranial fossa approach to the petroclival region, quantitative compare the advantages of endoscopic-assisted technique and the pure microscope exposure. Method:The enlarged middle cranial fossa approach was performed on 10 cases (20 sides) fresh adult cadaveric head specimens in which the vessels were injected with colored silicone. At the end of every enlarged middle cranial fossa approachs, endoscope assisted technique was applied. The effective working areas were measured under pure microscope and endoscopic-assisted technique. Result:The distance between the trigeminal nerve root entering the pons and the upper limit of exposure to the middle of the ventral brainstem under the microscope was（15.95±0.48）mm；the distance from the initial point of the acoustic-facial bundle to the lower bound of exposure to the middle of the ventral brainstem under the microscope was（10.79±0.51）mm；The distance between the trigeminal nerve root entering the pons and the upper limit of exposure to the middle of the ventral brainstem under endoscopy was（18.88±0.36）mm；the distance from the initial point of the acoustic-facial bundle to the lower bound of exposure to the middle of the ventral brainstem under endoscopy was（14.56±0.64）mm. Conclusion:In the anatomic study of the enlarged middle cranial fossa approach to the petroclival region, the endoscopic assistance has a larger effective exposure space and flexible perspective compared with the operation under the microscope, which is helpful to accurately locate the position and size of the lesion during surgery, accurately identify the important nerves and blood vessels surrounding the lesion, so as to improve the resection rate and reduce the recurrence rate.

Magnetic resonance imaging features of vascular leiomyoma of the ankle

Vascular leiomyoma is a benign soft tissue tumour with a predilection for middle-aged women. It is most often seen in the extremities, particularly in the lower leg. The typical lesion is a small, slow-growing subcutaneous nodule. These tumours are often unexpected or preoperatively confused with other soft tissue tumours including low-grade sarcomas, leading to wide surgical excision. This may partly be due to the relatively few studies delineating the characteristic imaging features of this entity. Here, the imaging findings of a case of vascular leiomyoma in the ankle are presented. Literature review of the magnetic resonance imaging findings of published reports and series of vascular leiomyomas of the extremities is also performed.

A systematic review of the efficacy and tolerability of hydroxyethylrutosides for improvement of the signs and symptoms of chronic venous insufficiency

WHAT IS KNOWN AND OBJECTIVE

Rutoside (rutin; quercetin rutinoside) is a glycoside found in various plant products, including apples, citrus fruits and cranberries. Hydroxyethylrutosides (HR) are semisynthetic derivatives sold as standardized products for the treatment of chronic venous insufficiency (CVI). Commercially available products include Relvène(®) (France), Venoruton(®) (Switzerland) and Paroven(®) (United Kingdom). However, the evidence for their efficacy is inconclusive. The aim of this systematic review was to evaluate the evidence of efficacy and tolerability of hydroxyethylrutosides for CVI.

METHODS

We searched electronic databases such as the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and CINAHL, and publisher databases, conference proceedings and references lists for randomized controlled trials published in English and non-English languages. We also performed hand searches for additional trials. We included all trials that assessed the effectiveness of HR for CVI. Comparisons include HR (with or without compression bandaging) vs. placebo (with or without compression bandaging) or HR vs. compression bandaging alone. Two review authors independently selected studies, extracted data and assessed risks of bias in the included trials.

RESULTS AND DISCUSSION

The search identified 1474 records. Only 15 trials involving 1643 participants met our inclusion criteria. A meta-analysis based on similar studies that compared HR with placebo showed that HR significantly reduced symptoms of pain (SMD -1·07, 95% CI -1·44 to -0·70), symptoms of heavy legs (OR 0·50; 95% CI 0·28-0·91) and cramps (SMD -1·07, 95% CI -1·45 to -0·69). No serious adverse effect due to HR was reported.

WHAT IS NEW AND CONCLUSION

The findings showed that HR produced modest improvements in several symptoms of CVI. However, all the included trials were of limited quality, and therefore, better-quality trials are still required to draw firm conclusions on the usefulness of HR for CVI.

Immunoglobulin G4-related sclerosing disease: experience with this novel entity in a local hospital

OBJECTIVE

To review the site of involvement, clinical presentation, and treatment outcome of patients having immunoglobulin G4-related sclerosing disease in a local regional hospital.

DESIGN

Retrospective case series.

SETTING

Pamela Youde Nethersole Eastern Hospital, Hong Kong.

PATIENTS

All patients with a diagnosis of immunoglobulin G4-related sclerosing disease in the hospital diagnosed in the period from April 2008 to March 2010.

RESULTS

A total of 12 patients with involvement of various organs were identified. There was a male predominance (male-to-female ratio=5:1). The mean age at diagnosis was 65 years. The salivary glands, biliary tract, pancreas, and cervical lymph nodes were the commonest involved sites. The immunoglobulin G4 level was elevated in 83% of the patients. Patients usually appeared to respond well to steroid treatment.

CONCLUSION

Immunoglobulin G4-related sclerosing disease is a systemic disease and can involve various systems.

Lymphotoxin: cloning, regulation and mechanism of killing

The gene for murine lymphotoxin (MuLT) has been cloned from a cDNA library prepared using poly(A)+ RNA from an activated murine IL-2-maintained cloned T cell line (21C11). This was accomplished with a MuLT BamHI fragment isolated from a murine genomic library by hybridization to a human LT cDNA probe. Northern blot analysis with RNA from 21C11, an L3T4+ (CD4+-equivalent) ovalbumin-specific class II-restricted T cell line, revealed a 15S band that hybridized to this MuLT fragment. A cDNA library prepared with poly(A)+ RNA from 21C11 cells contained 36 colonies that hybridized with the MuLT BamHI fragment. A full-length cDNA has been isolated, sequenced, expressed in COS-1 cells and used to map MuLT to mouse chromosome 17. The sequence and structure of the MuLT gene has been determined. MuLT cDNA has been used to analyse mRNA expression in several L3T4+ and Lyt-2+ (CD8+-equivalent) T cell clones activated with antigen, mitogen, or antibody to the T cell receptor. LT is expressed by both class I- and class II-restricted T cells. The mechanism of killing by both LT and the functionally related molecule TNF-alpha includes the induction of DNA fragmentation in the target cell.

[Associated sedation of propofol and midazolam in small dosage and gastroscopy]

OBJECTIVE

To search for a sedative method that is more suitable for gastroscopy.

METHODS

All of patients were randomly divided into control group and experimental group. The experimental group was treated with propofol and midazolam, the control group was treated with propofol alone. The cumulation dosage of propofol, sedative effect, variation of BP and SaO2 were observed in all patient.

RESULTS

The cumulative dosage of propofol in the experimental group was lower than that in the control group [(73.21 +/- 18.67) mg and (117.23 +/- 21.57) mg respectively]; the oblivious degree in the experimental group was higher than that in the control group (95.65% and 80.00%); the onset time and the descendant range of BP and SaO2 were also lower in the experimental than those in the control group. There was not remarkable difference in sedative effect and veriviscont time between the control group and the experimental group.

CONCLUSIONS

In such a rapid operation of gastroscopy, the dosage of propofol in the experimental group is obviously less than that in the control group, while it does not affect the effect of sedation, the diagnose and cure time in gastroscopy room, and has more security and less cost.

[Gly40Ser mutation of glucagon receptor gene and NIDDM in Han nationality]

OBJECTIVE

To ascertain whether Gly40Ser mutation in exon 2 of glucagon receptor (GCG-R) gene is associated with late-onset non-insulin-dependent diabetes millitus (NIDDM) in Chinese.

METHODS

We selected 82 NIDDM patients and 136 controls of Han nationality in Hunan province, and detected Gly40Ser mutation using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).

RESULTS

None of Gly40Ser mutation was found in all subjects.

CONCLUSIONS

The mutation doesn't associate with NIDDM in Chinese, even though the mutation was reported to be associated with NIDDM in certain French and Caucasians, genetic heterogeneity of NIDDM among ethnic groups should be considered.

Studies of the safety of Chinese wild rice

Chinese wild rice has been consumed for over 3000 years, but its safety as a food in China has never been established. The grain contains higher amounts of protein, ash and crude fibre than white rice. Levels of non-nutritive mineral elements such as arsenic, cadmium and lead are very low. The eating patterns of 110 people ( > 60 yr) showed no ill-effects. The results of acute toxicity tests with mice fed diet containing 21.5 g/kg Chinese wild rice [corrected] indicated no abnormal reaction and none of the mice died. The bone marrow micronucleus and sperm abnormality tests conducted with mice were negative as was the Salmonella mutagenicity test. The results of this investigation indicate that Chinese wild rice is safe for human consumption.

[Clinical trial of indapamide in the management of central diabetes insipidus]

To investigate antidiuretic effect of indapamide, ten patients with central diabetes insipidus (CDI) were observed with the treatment of 2.5-7.5 mg of indapamide per day. After the third day of therapy, their mean daily urine output reduced by about 50%, and urine osmolality increased 1.36 times. No further change was seen in urine volume and urine osmolality on the sixth day of treatment. This antidiuretic effect was similar to that of 50-75 mg dihydrochlorothiazide per day. No adverse reaction was observed in blood pressure and serum potassium concentration during indapamide therapy. These data suggest that indapamide may be a new drug in the management of CDI.

The murine lymphotoxin gene promoter. Characterization and negative regulation

Murine lymphotoxin (LT; TNF-beta) gene upstream regulatory elements were identified by linking fragments of 5' DNA to the chloramphenicol acetyl transferase gene. Fragment LT1 (-293 to +77 in relation to the proximal cap site) exhibited promoter activity which drove CAT expression in transfected murine fibroblasts and T lymphomas. Primer extension analysis of endogenous LT message confirmed that LT1 contained the necessary elements required for promoter function. Promoter activity was not observed when LT2 (-662 to +77), LT3 (-1186 to +77), or LT3 delta AX (-1186 to +77 (delta-662/-269)) were ligated to the chloramphenicol acetyl transferase gene and transfected into fibroblasts or T lymphomas. At least one upstream repressor element is postulated to account for this promoter inhibition. In contrast to the results obtained with fibroblast and T cell transfectants, LT1 was inactive in the B cell transfectants A20 and P3X63. This suggests that some B cells express a repressor factor that inhibits the LT promoter and/or they lack the necessary positive regulatory factors.

The murine lymphotoxin gene promoter. Characterization and negative regulation

Murine lymphotoxin (LT; TNF-beta) gene upstream regulatory elements were identified by linking fragments of 5' DNA to the chloramphenicol acetyl transferase gene. Fragment LT1 (-293 to +77 in relation to the proximal cap site) exhibited promoter activity which drove CAT expression in transfected murine fibroblasts and T lymphomas. Primer extension analysis of endogenous LT message confirmed that LT1 contained the necessary elements required for promoter function. Promoter activity was not observed when LT2 (-662 to +77), LT3 (-1186 to +77), or LT3 delta AX (-1186 to +77 (delta-662/-269)) were ligated to the chloramphenicol acetyl transferase gene and transfected into fibroblasts or T lymphomas. At least one upstream repressor element is postulated to account for this promoter inhibition. In contrast to the results obtained with fibroblast and T cell transfectants, LT1 was inactive in the B cell transfectants A20 and P3X63. This suggests that some B cells express a repressor factor that inhibits the LT promoter and/or they lack the necessary positive regulatory factors.

Amniotic fluid lecithin/sphingomyelin ratio in high risk pregnancy

The amniotic fluid lecithin/sphingomyelin (L/S) ratio from 128 cases of high risk pregnancies were measured by using high performance liquid chromatography (HPLC). The L/S ratio was found to be increased in patients with pre-eclampsia, hypertension, intrauterine growth retardation (IUGR), prolonged rupture of membranes (PROM), and twin gestation, but decreased in patients with diabetes from gestational diabetes to class C. In patients with placenta previa, the L/S ratio was not affected.

Validity of lung correction algorithms

Our studies have compared the "effective tissue-air ratio (TAR) method" (ICRU Report No. 24), "equivalent TAR method," and the "generalized Batho method" (currently used by the TP-11 computer treatment planning system) with measured results for different energy photon beams using two lung inhomogeneities to simulate a lateral chest field. Significant differences on the order of 3%-15% were found when comparing these various methods with measured values.