Inner ear anomalies in two cases of trisomy 18

Two cases of trisomy 18 in which temporal bone defects were limited to the inner ears are described. Several abnormalities were present that have not been described previously in this syndrome. The first case involved a 1-month-old female infant who died of congenital heart defects. Cochlear nerve fibers were absent on the left side, with near-normal innervation on the right. Although the organ of Corti was present bilaterally, some of the outer hair cells were deformed, having small rounded cell bodies unsupported by Deiters' cells. On the right, similar abnormal cells were found in the tunnel of Corti. Vestibular defects in this case included reduced nerve supply of the left saccular macula, cysts in the superior and posterior cristae, and absence of the utriculoendolymphatic valve. The second case involved a newborn male infant with multiple congenital anomalies. The major cochlear defect was a deformity of the stria vascularis. In the lower apical turn, the stria was adherent to Reissner's membrane and extended beneath it into scala media. Large capillaries, which ran freely suspended in scala vestibuli, entered the upper portion of the stria. Severe atresia of the lateral and posterior semicircular ducts was found in the vestibular apparatus.     

Plantar fasciitis in patients with type 1 and type 2 diabetes: A contemporary cohort study

ObjectiveHyperglycemia leads to increase advanced glycation end products (AGEs) in patients with type 1 and type 2 diabetes. Subsequently, formation of AGEs can cause increased plantar fascial thickness (PFT), an imaging feature of plantar fasciitis (PF). This study evaluates the prevalence of PF in a contemporary cohort of type 1 diabetes and type 2 diabetes patients managed according to current standards, compared to patients without diabetes.Research design and methodsThis is a five-year prevalence study in a large tertiary health system (approximately 535,000 patients/visits/year) with a single electronic medical record (EMR), applying a cohort discovery tool and database screen (Data Direct) with use of ICD-9 and ICD-10 codes. All patients with a PF diagnosis between 01/01/2011 and 01/01/2016 were included and divided into 3 groups: type 1 diabetes (7148 patients), type 2 diabetes (61,632 patients), and no diabetes (653,659 patients). Prevalence rates were calculated, accounting for other risk factors including BMI and gender using Fisher's exact test.ResultsThe overall prevalence of PF in the entire study population was 0.85%. Prevalence rates were higher in patients with diabetes, particularly with type 2 diabetes (42% and 64% higher compared with patients with type 1 diabetes and no diabetes respectively). Individually, PF rates were 0.92% in type 1 diabetes and 1.31% in type 2 diabetes compared with 0.80% in patients with no diabetes (Type 1 vs. no diabetes p = 0.26; Type 2 vs. no diabetes p ? 0.0001; Type 1 vs. Type 2 diabetes p = 0.0054). Females in all groups had higher prevalence of PF than males (p ? 0.0001 for all), with those patients with diabetes having higher prevalence rates than those without diabetes. Patients with higher BMI levels (BMI ≥ 30 kg/m²) were also more likely to have PF in all categories except males with type 1 diabetes (p = 0.40).ConclusionsIn this large contemporary population managed in a tertiary health system, prevalence rates of PF were substantially higher in patients with diabetes compared with no diabetes, particularly in type 2 diabetes. Female gender and higher BMI were also associated with higher prevalence of PF in this cohort.     

Patterns of Incident Reporting Across Clinical Sites in a Regionally Expanding Academic Radiation Oncology Department

PurposeWe evaluated patterns of event reporting across five clinical locations within an academic radiation oncology department, with the goal of better understanding variability across sites.Methods and MaterialsWe analyzed 1,351 events reported to a departmental incident learning system over 1 calendar year across the five locations with respect to volume of events, event type, process map location of origin and detection, and event reporter.ResultsWe found marked variability in reporting patterns, including reporting rate, event type, event severity, event location of origin and detection within the departmental process map, and discipline of event reporters. These differences relate both to variability in process and workflow (reflected by frequency of specific workflow events at each site) and in reporting culture (reflected by volume or rate of event reporting, and discipline of event reporter).ConclusionsThese data highlight the variability in reporting culture even within a single department, and therefore the need to tailor and individualize safety and quality programs to the unique clinical site, with the long-term goal of achieving a common culture of safety while supporting unique processes at individual locations. This work also raises concern about extrapolating single-institution incident learning system results without understanding the unique workflow and culture of clinical sites.     

精液中白细胞两种鉴别方法的比较与评价

用瑞氏－姬姆萨染色法和免疫细胞化学法对１２６名不育男性进行了精液白细胞检测，白细胞检出率分别为６６．６７％和６９．０５％，两法符合率为９２．１％，两法是一步提高精液中白细胞检测水平。     

黑刺菝葜根茎中蒽醌类化学成分的研究

目的 对黑刺菝葜Smilaxscobinicaulis根茎的化学成分进行研究。方法 运用硅胶、Sephadex LH-20凝胶和MCI Gel等柱色谱方法进行分离纯化,根据化合物的理化性质和波谱数据鉴定化合物结构。结果 从黑刺菝葜70%乙醇提取物的石油醚和醋酸乙酯萃取部位分离得到13个化合物,分别鉴定为芦荟大黄素（1）、甲基异茜草素-1-甲醚（2）、1, 3, 6, 8-四羟基蒽醌（3）、大黄素（4）、8-羟基-1-甲氧基-3-甲基蒽醌（5）、大黄酚（6）、多花二醌A（7）、多花二醌C（8）、24-乙基胆甾- 4-烯-3, 6-二酮（9）、5α, 8α-过氧化麦角甾-6, 22-二烯-3β-醇（10）、(22E, 24R)-24-甲基-5α-胆甾-7, 22-二烯-3β, 5, 6β-三醇（11）、missourin（12）、齐墩果酸（13）。结论 化合物1～13均为首次从该植物中分离得到,其中化合物1～3和5～13为首次从菝葜属植物中分离得到。     

Comparison of the quality of smears in transbronchial fine-needle aspirates using two staining methods for rapid on-site evaluation

Transbronchial needle aspiration (TBNA) via flexible bronchoscopy is a well-established sampling modality for lung masses. The procedure is useful in the diagnosis of neoplastic and non-neoplastic lesions as well as for staging of bronchogenic carcinoma. Rapid on-site evaluation (ROSE) adds value as it has the advantage of triaging material during the procedure so avoiding a battery of investigations. Frequently used rapid stains are the modified Wright-Giemsa water-based stain (WG-ROSE) and the alcohol-based modified Papanicolaou stain (Pap-ROSE). Final review of laboratory-based Giemsa and Pap stains supplemented by ancillary investigations is essential for quality assurance. To investigate whether and how ROSE influenced the quantity and quality of the material submitted to the laboratory we randomized 126 patients to WG-ROSE, requiring only one pathologist on-site, or combined WG- and Pap-ROSE, requiring an additional person on-site to assist with staining. In those patients with positive TBNA we graded the laboratory-based slides of the first pass containing diagnostic material into insufficient, suspicious, adequate and excellent. The first diagnostic pass was found after 3.06 ± 1.94 (SD) passes and 3.13 ± 2.16 passes with WG-ROSE and combined ROSE (P = 0.87), respectively. Following WG-ROSE and combined ROSE 69% and 71.1% (P = 0.509) of slides were diagnostic (adequate or excellent) on laboratory-based Giemsa stains, and 93.3% and 100% (P = 0.134) were scored adequate or excellent on laboratory-based Pap stains. We concluded that the less costly and labour intensive WG-ROSE procedure is adequate for TBNA. This has cost implications especially in resource poor settings.     

从黄姜中提取薯蓣皂苷元的工艺研究

薯蓣皂苷元是合成甾体激素类药物的重要中间体。本文阐述了从黄姜中提取薯蓣皂苷元的各种工艺路线的研究进展,并对其生产工艺路线的发展前景进行了分析。     

Homer Wright rosettes in ependymoma

Summary A brain tumor in the fourth ventricle of a 26-year-old woman displayed numerous Homer Wright rosettes by conventional histology, but immunostaining and electron microscopy revealed the tumor an ependymoma. Since the presence of Homer Wright rosettes in ependymoma has not been well appreciated in the past, the diagnostic importance of this finding is discussed.