Search

The publication of A Randomized Trial of Induction Versus Expectant Management (ARRIVE), conducted in the United States in 2018, heralded a paradigm shift within the obstetrical management of term pregnancy among people who have not previously given birth. ARRIVE finds its home among other canonical - and controversial - randomized controlled trials (RCTs) within obstetrics. We argue that RCTs have their own (after)life, both creating new subjects for biomedical intervention and recalibrating who reproductive health practitioners consider to be at risk of adverse health outcomes. These data have important consequences for medical social scientific engagement with RCTs to further interrogate the questions of risk and intervention within reproductive health.

A 52-year-old patient was initially diagnosed as hypophosphatemic osteomalacia in the Department of Endocrinology due to knee, foot and lumbosacral pain. The symptoms were not significantly relieved after phosphorus and vitamin D supplementation. Later, the imaging examination showed an orbital tumor in the right eye. The tumor was surgically removed, and the symptoms of systemic bone pain were relieved.1例52岁患者初期因双膝、双足及腰骶疼痛，就诊于内分泌科诊断为低磷性骨软化症。给予补磷、补维生素D治疗，症状未见明显缓解。其后影像学检查发现右眼眶肿物，通过手术切除眼眶肿瘤，患者全身骨痛症状缓解。.

细胞外囊泡是几乎所有细胞均能向外分泌的具有膜结构的纳米级囊泡，在细胞间信号通信中起重要作用。细胞外囊泡包括外泌体、微泡及凋亡小体，能够将蛋白质、脂质、核酸等生物活性物质转运至靶细胞，参与机体生理状态的维持及多种疾病的发生、发展。本综述主要介绍细胞外囊泡在慢性鼻窦炎和变应性鼻炎中的研究进展，以期为这2种疾病的发病机制及潜在治疗靶点的研究提供新思路。.

The Esophageal Cancer Committee of the Chinese Anti-Cancer Association have released 《Chinese expert consensus on mediastinal lymph node dissection in esophagectomy for esophageal cancer (2017 edition)》. This consensus provides guidance to standardize mediastinal lymph node dissection in esophagectomy for esophageal cancer in China, and represents the first Chinese version of naming and grouping mediastinal lymph nodes for esophageal cancer. However, controversies exist in N staging. The aim of this article is to discuss whether N staging should base on the number of lymph node metastases, or base on the region in which the metastatic lymph nodes are located.2017年中国抗癌协会食管癌专业委员会发布了《食管癌根治术胸部淋巴结清扫中国专家共识(2017版)》，是国内最先发表的关于食管癌胸部淋巴结清扫的规范化指导意见，对胸部淋巴结清扫数目和分组进行了详细的说明和推荐。文章主要针对食管癌胸部区域淋巴结清扫中，应以淋巴结分组还是个数为标准这一争议问题，对共识做出解读，以期为食管癌根治术中胸部淋巴结清扫的标准提供参考。.

Medical treatment of ovarian cancer is based on chemotherapy. Most patients, regardless of the initial stage of their disease, will need to be treated (grade A). Standard treatment relies on a carboplatin and paclitaxel combination (grade A). For advanced diseases (stage I-IIA1 or IIIB à IV), the addition of an antiangiogenic treatment with bevacizumab to the chemotherapy, followed by a maintenance for 15 months should be proposed as it allows better disease control (grade A). For patients with somatic or germline BRCA mutations and disease stage III or IV, olaparib is recommended as maintenance treatment for 24 months (grade B, but olaparib had not the French approval as first-line treatment at the time of the present recommendation editing). No other targeted therapy or immunotherapy has yet been proven effective at the initial phase of ovarian cancer treatment. The treatment of rare tumors with a special histology must be discussed in a specialized multidisciplinary meeting of the network of rare malignant tumors of the ovary (TMRO) labeled by the INCa.

Adjuvant chemotherapy with carboplatin and paclitaxel is recommended for all high-grade ovarian or Fallopian tube cancers, stage FIGO I-IIA (grade A). After a complete first surgery, it is recommended to deliver 6 cycles of intravenous (grade A) or to propose intraperitoneal (grade B) chemotherapy, to be discussed with patient, according to the benefit/risk ratio. After a complete interval surgery for a FIGO III stage, the hyperthermic intra peritoneal chemotherapy (HIPEC) can be proposed in the same conditions of the OV-HIPEC trial (grade B). In case of tumor residue after surgery or FIGO stage IV, chemotherapy associated with bevacizumab is recommended (grade A). For BRCA mutated patient, Olaparib is recommended (grade B).

Faced to an undetermined ovarian mass on ultrasound, an MRI is recommended and the ROMA score (combining CA125 and HE4) can be proposed (grade A). In case of suspected early stage ovarian or fallopian tube cancer, omentectomy (at least infracolonic), appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C) and pelvic and para-aortic lymphadenectomy are recommended (grade B) for all histological types, except for the expansive mucinous subtype where lymphadenectomy may be omitted (grade C). Minimally invasive surgery is recommended for early stage ovarian cancer, if there is no risk of tumor rupture (grade B). Laparoscopic exploration for multiple biopsies (grade A) and to evaluate carcinomatosis score (at least using the Fagotti score) (grade C) are recommended to estimate the possibility of a complete surgery (i.e. no macroscopic residue). Complete medial laparotomy surgery is recommended for advanced cancers (grade B). It is recommended in advanced cancers to perform para-aortic and pelvic lymphadenectomy in case of clinical or radiological suspicion of metastatic lymph node (grade B). In the absence of clinical or radiological lymphadenopathy and in case of complete peritoneal surgery during an initial surgery for advanced cancer, it is possible not to perform a lymphadenectomy because it does not modify the medical treatment and the overall survival (grade B). Primary surgery is recommended when no tumor residue is possible (grade B).

Objective To study the protein expression of cluster of differentiation 63 （CD63） in lung tissues of guinea pigs that died of anaphylactic shock and discuss the diagnostic value of CD63 for death from anaphylactic shock. Methods Twenty guinea pigs were randomly divided into control group, anaphylactic shock immediate death group, cold storage group （4 ℃ for 48 h） and frozen group （-20 ℃ for 7 d）. The animal model of guinea pigs that died of anaphylactic shock was established with human mixed serum injection. The expression changes of CD63 protein and CD63 mRNA in lung tissues were detected by hematoxylin-eosin （HE） staining, immunohistochemical staining, Western blotting, enzyme-linked immunosorbent assay （ELISA） and real-time RT-PCR. Results HE staining results showed congestion, and edema of lung tissues, and eosinophil infiltration in the anaphylactic shock groups. Western blotting analysis results showed that the expression of CD63 protein in the lung tissues of guinea pigs that died of anaphylactic shock was significantly higher than that in the control group （过敏性休克死亡豚鼠肺组织中CD63的表达.目的 研究过敏性休克死亡豚鼠肺组织中分化抗原簇63（cluster of differentiation 63，CD63）的蛋白表达，探讨CD63对过敏性休克死亡的诊断价值。 方法 20只豚鼠随机分为对照组，过敏性休克死亡即刻组、冷藏组（4 ℃贮藏48 h）、冷冻组（-20 ℃贮藏7 d）。采用人混合血清注射建立过敏性休克死亡豚鼠动物模型。应用苏木精-伊红（hematoxylin-eosin，HE）染色、免疫组织化学染色、Western印迹法、酶联免疫吸附测定（enzyme-linked immunosorbent assay，ELISA）和real-time RT-PCR检测肺组织中CD63蛋白及CD63 mRNA的表达变化。 结果 HE染色结果显示，各过敏性休克组肺组织淤血、水肿，嗜酸性粒细胞浸润。Western印迹法检测结果显示，过敏性休克豚鼠肺组织中CD63蛋白表达高于对照组（法医病理学；过敏反应；休克；肺；分化抗原簇63；豚鼠.

Dapsone is used in the treatment of infections and inflammatory diseases. The dapsone hypersensitivity syndrome, which is associated with a reported mortality of 9.9%, develops in about 0.5 to 3.6% of persons treated with the drug. Currently, no tests are available to predict the risk of the dapsone hypersensitivity syndrome.We performed a genomewide association study involving 872 participants who had received dapsone as part of multidrug therapy for leprosy (39 participants with the dapsone hypersensitivity syndrome and 833 controls), using log-additive tests of single-nucleotide polymorphisms (SNPs) and imputed HLA molecules. For a replication analysis, we genotyped 24 SNPs in an additional 31 participants with the dapsone hypersensitivity syndrome and 1089 controls and performed next-generation sequencing for HLA-B and HLA-C typing at four-digit resolution in an independent series of 37 participants with the dapsone hypersensitivity syndrome and 201 controls.Genomewide association analysis showed that SNP rs2844573, located between the HLA-B and MICA loci, was significantly associated with the dapsone hypersensitivity syndrome among patients with leprosy (odds ratio, 6.18; P=3.84×10(-13)). HLA-B*13:01 was confirmed to be a risk factor for the dapsone hypersensitivity syndrome (odds ratio, 20.53; P=6.84×10(-25)). The presence of HLA-B*13:01 had a sensitivity of 85.5% and a specificity of 85.7% as a predictor of the dapsone hypersensitivity syndrome, and its absence was associated with a reduction in risk by a factor of 7 (from 1.4% to 0.2%). HLA-B*13:01 is present in about 2 to 20% of Chinese persons, 1.5% of Japanese persons, 1 to 12% of Indians, and 2 to 4% of Southeast Asians but is largely absent in Europeans and Africans.HLA-B*13:01 was associated with the development of the dapsone hypersensitivity syndrome among patients with leprosy. (Funded by the National Natural Science Foundation of China and others.).

To investigate the impact of coal workers' pneumoconiosis complicated by the pathological changes in lymph nodes in lung cancer on surgical treatment.A total of 63 patients with non-small cell lung cancer who received pulmonary lobectomy and systemic mediastinal lymph node dissection were enrolled and divided into the group with coal workers' pneumoconiosis complicated by lung cancer (30 patients) and the non-pneumoconiosis liver cancer group (33 patients). The short-term outcome was compared between the two groups and confirmed by lymph node fibrosis shown by postoperative pathological examination. The predictive value of lymphadenectasis on chest CT was analyzed.Compared with the non-pneumoconiosis liver cancer group, the group with coal workers' pneumoconiosis complicated by lung cancer had significant increases in time of operation, intraoperative blood loss, postoperative extubation time, and length of hospital stay (P0.05). The patients were divided into groups according to the presence or absence of lymph node fibrosis, and the group with lymph node fibrosis had a significantly longer time of operation and greater intraoperative blood loss than the group without lymph node fibrosis (P0.05).When coal workers' pneumoconiosis is complicated by lung cancer, severe lymph node fibrosis often causes difficulties in surgery, and thoracotomy may be a safe and effective therapeutic method.

Acute myocardial ischemia is the most common cause of sudden cardiac death. The diagnosis of early myocardial ischemia is a hot point in forensic medicine, which is also an early and important part for a prevention against myocardial infarction. This paper conducts a comprehensive discussion of the structure, function, clinical value and forensic medicine application prospect of ischemia modified albumin （IMA） and heart-type fatty acid binding protein （H-FABP), aiming to determine whether the two proteins can be used as biochemical detection indicators of early myocardial ischemia for the diagnosis of sudden cardiac death in forensic medicine.

Fudosteine is a novel mucoactive agent, although little is known about how fudosteine decreases mucin production. The present study examined the effects of fudosteine on MUC5AC mucin synthesis and cellular signalling. An animal model of lipopolysaccharide (LPS)-induced inflammation and a bronchial epithelial cell line model of tumour necrosis factor (TNF)-alpha-induced inflammation were used. Fudosteine was administered before stimulation with LPS or TNF-alpha. The MUC5AC mucin levels were assayed and the expression of the MUC5AC gene was measured. Western blotting was carried out for the detection of phosphorylated epidermal growth factor receptor (p-EGFR), phosphorylated p38 mitogen-activated protein kinase (p-p38 MAPK) and phosphorylated extracellular signal-related kinase (p-ERK). MUC5AC mucin synthesis and the expression of the MUC5AC gene were increased by LPS in rats or TNF-alpha in NCI-H292 cells; these effects were inhibited by fudosteine treatment. After stimulation with LPS or TNF-alpha, the expression of p-EGFR, p-p38 MAPK and p-ERK were detected. Fudosteine treatment reduced the expression levels of p-p38 MAPK and p-ERK in vivo and of p-ERK in vitro. The present results suggest fudosteine inhibits MUC5AC mucin hypersecretion by reducing MUC5AC gene expression and the effects of fudosteine are associated with the inhibition of extracellular signal-related kinase and p38 mitogen-activated protein kinase in vivo and extracellular signal-related kinase in vitro.

The purpose of this study was to evaluate the relationship between zinc and the growth and development of young children. The parents of 8102 young children were surveyed in person by a trained surveyor using structured questionnaires. The hair zinc concentration of the children was determined using an atomic absorption spectrophotometer. The height, weight, sitting height, and head circumference of the children were measured at follow-up visits. There was a positive correlation between hair zinc concentration and adaptive developmental quotient (ADQ; r = 0.3164, P = 0.0272) while no correlation was found between hair zinc concentration and body measurement Z scores or intelligence quotient (IQ). There was a strong positive correlation between hair zinc concentration and weight-for-age Z scores (r = 0.3618, P = 0.0416) and ADQ (r = 0.2761, P = 0.0387) in boys; there was no correlation between hair zinc concentration and body measurement Z scores, IQ, and ADQ in girls. In boys with normal hair zinc levels, ADQ was 9.58 (P = 0.0392), higher than in boys who had zinc-deficient hair. In girls with normal hair zinc levels, ADQ was 2.52 (P = 0.0296), lower than in girls with zinc-deficient hair. In conclusion, there is no significant correlation between hair zinc levels and IQ or Z scores for all body measurements in young children.

To investigate the relationship between the pulse wave velocity (PWV) and angiographic carotid atherosclerosis in elderly patients.103 consecutive elderly patients were divided into two groups according to the results of cerebral angiography: carotid atherosclerosis group and normal carotid angiogram group. Basic clinical information was required by a standardized questionnaire. Carotid-femoral PWV (cfPWV) as a marker of Stiffness of artery was measured, Carotid intima media thickness (IMT) and carotid stenosis degree in angiography was evaluated. Independent-sample t test was used to evaluate the difference in cfPWV between the two groups, Bivariate associations between cfPWV and an index of extracoronary atherosclerosis (IMT and severity of stenosis) was performed.Among 103 subjects, 55 with carotid atherosclerosis and 48 with a normal carotid angiogram, a significant difference between the two groups in IMT and PWV was found (P0.05), and the cfPWV was significantly correlated with IMT (r = 0.3222, P = 0.0315), but not severity of carotid stenosis (r = 0.1573, P = 0.3137).cfPWV showed a positive correlation to carotid IMT, and maybe is a potentially useful adjunctive atherosclerotic risk marker to Identify of early carotid atherosclerosis.

Aims To determine the feasibility of radiotherapy-associated capecitabine, irinotecan and oxaliplatin administration at five dose levels for the treatment of locally advanced rectal cancer, with or without metastasis. Patients and methods This was a bicentric phase I trial, including patients with locally advanced rectal cancer, with or without metastasis. Chemotherapy comprised capecitabine (1100, 1300 or 1500mg/m 2 /day, every day), irinotecan (30, 40 or 50mg/m 2 , once per week for 6 weeks) with the addition of oxaliplatin (40mg/m 2 at level 4 or 50mg/m 2 at level 5, once per week for 6 weeks). Radiotherapy at 46Gy plus a boost of 4Gy was administered concomitantly. Results Twelve patients received four levels of dose. As a supplement to radiotherapy, the combination of capecitabine and irinotecan at the respective doses of 1500mg/m 2 /day and 50mg/m 2 /week was feasible and well tolerated. The addition of oxaliplatin to this combination provoked toxicity (grade 3/4 vomiting, diarrhoea) for two-thirds of the patients. Conclusion A treatment associating radiotherapy (46Gy+4Gy) with concomitant chemotherapy comprising capecitabine (1500mg/m 2 /day, every day) and irinotecan (50mg/m 2 /week, for 5 weeks) was feasible and well tolerated. The addition of oxaliplatin to these doses was prohibitory to the continuation of treatment due to unacceptable toxicity.

To investigate the K-ras gene mutations in asbestos and welding-fumes related human lung cancer (hLC), comparing with the mutational spectrum of K-ras gene in non-occupational hLC, 8 cases of non-occupational hLC, 9 cases of asbestos-related hLC and 4 cases of welding-fumes related hLC were collected. The techniques of genomic DNA extraction, nested-polymerase chain reaction (PCR), polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP), polymerase chain reaction single-strand conformation polymorphism (PCR-SSCP) and DNA direct sequencing were employed.showed the mutation frequencies of K-ras gene were 25% in non-occupational hLC and welding-fumes related hLC, whereas 44.4% in asbestos-related hLC. Mutations mainly occurred in codons 12 and 15. A mutation of codon 13 was detected in welding-fumes related hLC. The type of base substitution was principally G--T transversion in non-occupational hLC, whereas mainly G--A transition in asbestos and welding-fumes related hLC. THE RESULTS suggested there were obvious differences of K-ras gene mutations among non-occupational hLC, asbestos and silica related hLC. Therefore, different mechanisms of carcinogenesis were implicated among them. However, no speific spectrum of K-ras gene mutation can be derived from welding-fumes related hLC because of the limitation of samples.

In order to investigate the effect of expanded polytetrafluoroethylene (e-PT-FE) in repair of facial depression.From February 1997 to July 1998. The e-PTFE was used as a filling and suspending material for facial depression and facial nerve palsy in 6 cases. They were followed up for 2-16 months.After filling of the facial depression, the deformed side of the face became symmetrical to that of contralateral side, and those following the suspending technique using this material the affected eyelids could close completely and the oral corners were symmetrical in its static status.The expanded PTFE was a safe, biocompatible and easily applied material, especially served as a filling or suspending material in the repair of facial depression with facial nerve palsy.

To explore the relationship between genetic variation in coagulation factor V and the occurrence of coronary arterial disease (CAD).Unrelated 86 patients with CAD and 102 healthy controls were analyzed by polymerase chain reaction-denaturing gradient gel electrophoresis (PCR-DGGE) to detect variations in the entire twenty-five exons of the factor V gene.Polymorphisms in exon 4 [642 G--T (Ser156)], exon 10 [1628 G--A (Arg485Lys)], exon 13 [4070 A--G (His1299Arg)] and exon 16 [5380 G--A (Val1736Met)] were documented. The study also identified a novel polymorphism in exon 2 (327 A--G) which did not result in amino acid residue substitution. The Leiden mutation (Arg506Gln) was not detected in any of our 188 subjects. Among the 5 polymorphisms, the allele frequency of 1628 G--A was significantly different between CAD patients and controls (0.69 vs 0.81, chi 2 = 6.908, P0.01). This is the first report of this finding in a Chinese population.1628 G--A polymorphism is associated with CAD and it may be a risk factor for CAD morbidity in the Chinese population.

To report our initial experience of the first 5 cases of partial left ventriculectomy (PLV or Batista operation), a new surgical therapy for treatment of end-stage dilated cardiomyopathy in China.From April to August 1998, 5 patients with idiopathic dilated cardiomyopathy received PLV at Anzhen Hospital. The mean age of the patients was 48.4 years (range: 42 to 53 years). Three patients were in New York Heart Association (NYHA) class III and 2 in class IV. All patients had mitral valve insufficiency (3 moderate and 2 severe) and 1 had severe tricuspid valve insufficiency in addition preoperatively. Cardiopulmonary bypass and cardiac arrest with cold blood cardioplegia were used in all patients. The average weight of the resected left ventricle muscle was 46.3 g. All patients underwent mitral annuloplasty and 1 plus tricuspid annuloplasty (De Vega).Echocardiography demonstrated a significant decrease in left ventricular diastolic diameter (8.4 +/- 1.1 cm to 5.4 +/- 0.4 cm, P0.01) and an increase in ejection fraction (17.78% +/- 6.26% to 34.82% +/- 3.18%, P0.025). One patient died of heart failure on the 6th postoperative day. The mean follow-up period of the 4 discharged patients were 4 months (from 3 to 6 months). One were in NYHA class I and 3 in class II; all had a normal life.Batista operation is a new and valuable alternative of the surgical treatment for end-stage dilated cardiomyopathy and the long-term results need further studies.

Crystalline silica was recently classified as a human carcinogen by the International Agency for Research on Cancer (IARC). However, the direct genotoxic effect of silica in humans remains unclear. We examined the p53 and K-ras gene mutations in lung cancer in workers with silicosis (LCWS). DNA was extracted from paraffin-embedded tissues and examined by PCR-RFLP, PCR-SSCP, and DNA sequencing. The mutation frequencies of p53 gene were high, but the mutation distributions in exons and among the histological types of LCWS differed from those of common (i.e., not silicosis-related) lung cancer. Furthermore, no mutations in codon 12 of K-ras gene (predominant in common lung cancer) were found in LCWS. These findings in the mutational spectrum support a carcinogenic effect of silica dust at the DNA molecular level.

Inherited predisposition to thrombosis contributes to the initiation and progression of coronary artery disease (CAD). The present study was designed to explore the relationship between genetic variation of coagulation factor V and occurrence of CAD. A total of 141 unrelated patients with CAD and 175 healthy controls were analyzed by polymerase chain reaction-denaturing gradient gel electrophoresis (PCR-DGGE) for variation detection in all 25 exons of the factor V gene. Among the study subjects, 55 CAD patients and 73 controls were evaluated at random for response to activated protein C (APC) by Coatest APC resistance test. Polymorphisms in exon 4, 10, 13 and 16 of factor V gene were documented [642G--T(S156), 1628--A(R485K), 4070A--G(H1299R) and 5380G A(V1736M), respectively]. The study also identified a novel polymorphism 327A G in exon 2 which did not alter the amino acid residue. Leiden mutation (R506Q) was not detected in any of our 316 subjects. Among the five polymorphisms, the allele frequency of 1628G--A was significantly different between the CAD patients and the controls (0.36 vs. 0.21, p0.05). Subjects homozygous or heterozygous for the A allele of 1628G--A polymorphism had lower normalized APC ratios than those with the GG genotype in the CAD group (1.16+/-0.13 and 1.18+/-0.23 vs. 1.36+/-0.33, p0.05) and in the controls, indicating that A(1628) allele was associated with a poor response to APC. We conclude that the 1628G--A (R485K) polymorphism of factor V is associated with a poor response to APC and increased risk for CAD.

The concomitant presence of five distinct HIV-1 subtypes and of unclassified HIV-1 was reported in Bangui, Central African Republic (C.A.R.) between 1990 and 1991. This previous study was conducted in individuals belonging to the C.A.R. Armed Forces (FACA) Cohort and in patients from the University Hospital of Baugui. To follow the HIV-1 subtype distribution in Bangui over time, we conducted a cross-sectional surveillance of HIV-1 subtypes between 1987 and 1997 in three groups of individuals in Bangui: 47 men belonging to the FACA Cohort, 38 patients from the CNHUB hospital, and 51 individuals consulting the sexually transmitted diseases (STD) clinic. One hundred and ten HIV-1 were subtyped by heteroduplex mobility assay (HMA) and/or sequencing of env regions encompassing the V3 domain. By comparing the HIV-1 distribution in two time periods (1987-1991 and 1991-1996) in the FACA cohort, we observed a significant increase of subtype A from 43.7% to 83.9%. This subtype distribution does not seem specific to the FACA cohort, in that subtype A accounted for 46.7% of the HIV-1 infections in CNHUB patients in the first time period studied and for 69.6% in the second time period. In STD patients, subtype A infections were predominant in 1995 (72.7%) and 1997 (89.7%). Subtype E viruses could be identified in the second time period, but represented only between 6.5% and 21.8% of the infections in the three groups of individuals studied. Other subtypes (B, C, H) and non-classified HIV-1 in C2-V3 were detected with only a 3.2% to 9.1% frequency for each in the second time period. Phylogenetic analysis excluded infection by a single source for the individuals included in the study. Our data demonstrate an increase in the proportion of HIV-1 subtype A infections in Bangui that raises the question of a preferential transmissibility of specific HIV-1 variants.

The shape of the capnogram is modified by airway obstruction, and the evaluation of this deformation, using measurable indices, could allow an indirect measurement of bronchial patency. A previous study undertaken in asthmatic subjects showed a good correlation between a capnographic index (end-tidal slope) and a spirometric parameter (forced expiratory volume in one second as a percentage of predicted (FEV1 %pred)) and suggested the study of other indices. The correlations between capnographic and spirometric indices were measured in 10 healthy subjects and 30 asthmatic patients. The usefulness of eight descriptive indices, analysing the successive phases of the capnogram, was assessed by measuring their reproducibility and their sensitivity to airway obstruction. The intraindividual and interindividual variabilities (Vi and VI) and the noise/signal ratio (Vi/VI) were measured by comparing the results of two successive capnographic measurements in 14 asthmatic subjects. The results show an increasing noise/signal ratio along the expiration (between 23 and 62%). Significant correlations between spirometry and capnography were found with all indices, but the strongest were observed with indices analysing the intermediate phase of the capnogram, that is the angle between the ascending phase (E2) and the alveolar plateau (E3). The correlations show that the analysis of the capnogram's shape is a quantitative method for evaluating the severity of bronchospasm. This ability, added to specific advantages (noninvasiveness, effort-independency, measurements during tidal breathing) opens new fields of application to capnography, such as measurement of bronchospasm in children and computerized monitoring of asthma.

The shape of the capnogram, which is related to uneven ventilation, is modified in obstructive diseases and especially during crisis of asthma. The most significant change is a rise in the slope of the "alveolar plateau". In this study, we measured the end-tidal slope (ETS) of the capnogram, calculated on 0.36 s before the end of expiration, and we compared this indice to usual spirometric measurements (FEV 1) in 21 control subjects and in 24 asthmatic subjects. The mean ETS in control subject was 0.08 +/- 0.06%/s, it was 0.3 +/- 0.23% in asthmatic subjects (p0.001). In the latter, we found a very significant correlation between ETS and FEV 1 (r = 0.83, p0.001). Thirteen asthmatic subjects were tested for a second time, immediately after inhalation of a beta 2-mimetic drug. They exhibit a very strong correlation between the rise of FEV 1 and the loss of ETS (r = 0.96, p0.001). These results show that the analysis of the capnogram's shape is a quantitative method for evaluating the severity of the bronchospasm. This ability, added to specific advantages (non-invasiveness, effort-independence) opens new fields of application to capnography: measurement of the bronchospasm in children, computerized monitoring of asthma.

The polymerase chain reaction (PCR) was used to identify mycobacterial DNA sequences in uncultured clinical specimens. Two oligonucleotide primers derived from the sequence of a gene that codes for the 65-kilodalton antigen of Mycobacterium tuberculosis amplified DNA from all 11 species of mycobacteria tested. Amplified DNAs of nontuberculosis mycobacteria were found to be approximately 20 to 40 bases shorter than those from M. tuberculosis and Mycobacterium bovis BCG. DNA equivalent to that present in as few as 40 M. tuberculosis cells either alone or in the presence of DNA equivalent to that in 10(6) human cells could be detected. Results from analysis of cultured bacteria and clinical specimens showed PCR was sensitive and specific both in detecting mycobacteria and in differentiating M. tuberculosis and BCG from other species of mycobacteria. The PCR method with the primers reported here may become a useful tool in the early and rapid detection of mycobacterial infections in uncultured clinical specimens.

Carbohydrate residues of various cells in human normal aortic intima, fatty streaks and atherosclerotic plaques were studied with 10 kinds of biotinylated-lectins by immunohistochemical techniques in 10 cases. The results showed that: (1) The amount of carbohydrate residues increased along with the progressing of atherosclerotic lesions. (2) The cells in atherosclerotic lesions could be marked by more than one kind of lectins. (3) Decrease of carbohydrate residues on the endothelial membrane might be considered helpful to the formation of fatty streak.

The thoracic localization of endometriosis may involve the pulmonary pleura and the diaphragm, or the bronchopulmonary parenchyma, according to mechanisms which appear to be quite different. The principal clinical manifestations express themselves depending on their localization, a pneumothorax in the first case and hemoptysis in the second. One clinical characteristic, however, applies to them all, a rhythm strictly related to periods. The current methods of visualization of the pleura enable a macroscopic diagnosis to occur in the former cases in 64% and the body scanner now localizes the second in all cases. Treatment by Danatrol is often strikingly effective in a few months, notably in the cases with parenchymal localization.

This pathology is not due to the drug but revealed or aggravated by it. The most commonly implicated drugs are the anti-inflammatory group, especially aspirin. However, the list of drugs liable to induce intolerance continues to grow. The clinical manifestations are mainly observed in middle age and may regress. Drug intolerance can be demonstrated by provocative tests; it can be limited by methods of drug tolerance. The most commonly pathogenic mechanisms are: -inflammatory mechanisms (role of kinin), -disturbance of the metabolism of arachidonic acid, prostaglandin blockage, stimulation of leukotrienes. This expanding pathogenic entity is independent though similar in many aspects to the immediate forms of allergy, so explaining its importance in the general field of pseudo-allergy.

Seven patients with Behcet's syndrome were given plasma exchanges (PE). They all had severe forms, essentially ocular, which had been previously treated by steroids and/or immunosuppressors for a number of years without effect on the course of the disease. The PE was associated with classical medical therapy in all cases. Four patients had daily PE on three consecutive days. Poor results were obtained in all cases with this technique. Five patients had monthly PE and a clinical improvement was observed in 4 cases, usually with a reduction in the number of exacerbations. All therapy failed in one patient who continued to have severe exacerbations. From this short series, PE would appear to be useful in chronic forms of the disease incompletely controlled by medical therapy. In these cases, PE should be repeated. However, a longer follow-up is necessary to confirm these results.