Congenital renal salt-losing syndrome and failure to thrive in infancy

An infant with congenital renal salt-losing syndrome is reported. The importance of recognizing this rare disorder is emphasized because early detection, and treatment with sodium supplementation, results in marked growth improvement and may prevent volume depletion, electrolyte disturbance, and cardiovascular collapse. The clinical features and biochemical abnormalities seen in the congenital renal salt-losing syndrome are described. In this condition, natriuresis occurs in the face of normal renal and adrenal function and, as the child gets older, spontaneous resolution occurs. Other causes of hyponatraemia in infancy are discussed.     

张伯礼教授治疗不寐的经验总结

张伯礼教授临证数十载,具有丰富的临床经验,常强调运用中医思维辨证论治。作者师从张伯礼教授学习,对张老师治疗不寐的临证辨治经验进行总结,即为滋阴降火,阳中求阴,交通阴阳,调心安神;温脾补肾,疏肝健脾,化源充沛,养血安神;潜降肝火,利胆湿热,通腑降浊,除烦安神;辛开苦降,斡旋枢机,调理脾胃,升清降浊;祛痰化湿,活血化瘀5种治疗大法。     

Risk Factors for Cardiovascular Disease,Metabolic Syndrome and Sleepiness in Truck Drivers

Background

Truck driver sleepiness is a primary cause of vehicle accidents. Several causes are associated with sleepiness in truck drivers. Obesity and metabolic syndrome (MetS) are associated with sleep disorders and with primary risk factors for cardiovascular diseases (CVD). We analyzed the relationship between these conditions and prevalence of sleepiness in truck drivers.

Methods

We analyzed the major risk factors for CVD, anthropometric data and sleep disorders in 2228 male truck drivers from 148 road stops made by the Federal Highway Police from 2006 to 2011. Alcohol consumption, illicit drugs and overtime working hours were also analyzed. Sleepiness was assessed using the Epworth Sleepiness Scale.

Results

Mean age was 43.1 ± 10.8 years. From 2006 to 2011, an increase in neck (p = 0.011) and abdominal circumference (p < 0.001), total cholesterol (p < 0.001), triglyceride plasma levels (p = 0.014), and sleepiness was observed (p < 0.001). In addition, a reduction in hypertension (39.6% to 25.9%, p < 0.001), alcohol consumption (32% to 23%, p = 0.033) and overtime hours (52.2% to 42.8%, p < 0.001) was found. Linear regression analysis showed that sleepiness correlated closely with body mass index (β = 0.19, Raj2 = 0.659, p = 0.031), abdominal circumference (β = 0.24, Raj2 = 0.826, p = 0.021), hypertension (β = -0.62, Raj2 = 0.901, p = 0.002), and triglycerides (β = 0.34, Raj2 = 0.936, p = 0.022). Linear multiple regression indicated that hypertension (p = 0.008) and abdominal circumference (p = 0.025) are independent variables for sleepiness.

Conclusions

Increased prevalence of sleepiness was associated with major components of the MetS.     

Molecular cloning of a house dust mite allergen with common antibody binding specificities with multiple components in mite extracts

Plaque radio-immuno assay has been used to isolate an IgE-binding clone from a lambda gt11 library of Dermatophagoides pteronyssinus cDNA. The clone HD6 contained DNA encoding a 215 residue protein which contained a predicted 17 amino acid residue leader sequence, no cysteines and a single N-glycosylation site. The 198 residue mature protein would have a predicted MW of 22,177 D. No homologues were found in searches of the data banks. Sera from 14/38 allergic children reacted strongly with the polypeptide produced by the clone (37%). Skin tests showed reactivity in 16/30 (53%) allergic patients and 0/10 of controls. Affinity purification of rabbit antibodies with the clone showed that antibodies to the polypeptide had specificities to multiple products in mite extracts corresponding to components of Mr 29, 27 and 24 K by Western blotting. Absorption studies of IgE in allergic serum indicated further entities at 13 and 11.5 kD. It is proposed to name this allergen Der p VII.     

Effect of treating lower urinary tract symptoms on anxiety, depression and psychiatric morbidity: A one-year study

BACKGROUND: The present study aimed to evaluate the effects of treating lower urinary tract symptoms (LUTS) on anxiety, depression and psychiatric morbidity following one year of follow-up. METHODS: A total of 297 patients were involved in this study. Patients were recruited into a surgical group (patients underwent transurethral resection of the prostate, n = 111), a medical group (underwent alpha-blockers treatment, n = 116) and a control group (renal stones patients with no or mild symptoms of severity, n = 70). Patients were assessed on anxiety, depression and psychiatric morbidity levels before and after treatment and were followed at 3, 6 and 12 months. RESULTS: The study showed that before treatment for LUTS, most of the patients, especially the surgical group compared to the medical and control groups, were more anxious, depressed and psychiatrically morbid. However, after treatment, most of the patients in the surgical group experienced a great improvement in their anxiety, depression and psychiatric morbidity level when compared to the medical and control groups. The reduction or improvement of their psychological profile was due to the reduction or total withdrawal of LUTS after treatment. CONCLUSION: Both medical and surgical treatment improved patient LUTS and thus improved their overall anxiety, depression and psychiatric morbidity.     

Construction of the Mandarin version of the International Prostate Symptom Score inventory in assessing lower urinary tract symptoms in a Malaysian population

BACKGROUND: The purpose of the present study was to validate the Mandarin version of the International Prostate Symptom Score (Mand-IPSS) in a Malaysian population. METHODS: The validity and reliability were studied in patients with lower urinary tract symptoms (LUTS; benign prostatic hyperplasia [BPH] group) and without LUTS (control group). Test-retest methodology was used to assess the reliability while Cronbach alpha was used to assess the internal consistency. Sensitivity to change was used to express the effect size index in the preintervention versus post-intervention score in patients with LUTS who underwent transurethral resection of the prostate. RESULTS: For the control group and BPH group, the internal consistency was excellent and a high degree of internal consistency was observed for all seven items (Cronbach alpha = 0.86-0.98 and 0.90-0.98, respectively). Test-retest correlation coefficients for all items were highly significant. Intraclass correlation coefficient (ICC) was high for the control (ICC = 0.93-0.99) and BPH group (ICC = 0.91-0.99). The sensitivity and specificity showed a high degree of sensitivity and specificity to the effects of treatment. A high degree of significance between baseline and post-treatment scores was observed across all seven items in the BPH group but not in the control group. CONCLUSIONS: The Mand-IPSS is a suitable, reliable, valid and sensitive instrument to measure clinical change in the Malaysian population.     

Atrioventricular Conduction in Sick Sinus Syndrome

With the increasing recognition of the pacemaker syndrome and with the availability of newer methods of pacing therapy, the status of the atrioventricular (AV) conduction in patients with Sick Sinus Sydrome (SSS) becomes crucial in the choice of mode of pacing. At the Philippine Heart Center, from April 1983 to November 1986, the sinus and AV node function studies of 46 patients who, by electrophysiological studies had sinus node dysfunction (SND)-SN recovery time (SNRT) >1400 msec, were reviewed. These were arbitrarily classified according to duration of SNRT into: Group A—borderline SND, SNRT from 1,401 to 1,499 msec (n = 4); Group B—mild SND, SNRT from 1,500 to 2,499 msec fn = 25); Group G—moderate SND, SNRT from 2,500 to 3499 msec fn = 6); Group D— severe SND, SNRT of 3,500 m and above (n = 11). Out of the 46, 14 (30%) had concomittant AVN dysfunction (AVND)—antegrade block rate < 130 beats per minute (BPM). The percentage occurrence of AVND was noted as follows: Group A—25% (1/4); Group B—28% (7/25); Group G—50% (3/6); Group D—27% (3/11). Out of the 14 patients with concomittant AVND, 5(35%) had antegrade block rate < 100 BPM, 3 in Group R and 2 in Group D. The study shows that AVND occurs in only 30% of SSS patients. Its occurrence and severity has no bearing on the degree of SND. In these, antegrade block was at a rate higher than 100 BPM in the majority of patients. The data suggest that most of SSS patients may benefit from atrial demand pacemaker which therapeutically is of more advantage over the ventricular demand type inasmuch as AV synchrony is retained, thus pacemaker syndrome is prevented.     

180例高危病例的冠状动脉搭桥术——停跳与不停跳手术的比较

目的比较体外循环冠状动脉搭桥手术(on-pumpcoronaryarteryby-passgrafting,(CABG)与不停跳冠状动脉搭桥手术(off-pumpcoronaryarterybypassgrafting,OPCAB)对高危手术病人术后死亡率、并发症发生率等的影响。方法从2002年1月至2003年11月,新加坡国立心脏中心共为180例高危冠状动脉粥样硬化性心脏病病人(欧洲心脏手术危险性评估系统Euroscore≥6分)行冠状动脉搭桥术,包括121例CABG(占67.2%)和59例OPCAB(占32.8%)。将两组病人术前、术中情况以及术后住院期间的死亡率、并发症发生率等分别进行比较。结果术后在血制品的应用、呼吸机辅助时间、呼吸功能不全的发生率、ICU滞留天数以及住院天数等方面,OPCAB均明显优于CABG。结论OPCAB对高危冠心病病例具有良好的可行性,与CABG相比,具有明显的优越性。     

180例高危病例的冠状动脉搭桥术——停跳与不停跳手术的比较

目的:比较体外循环冠状动脉搭桥手术(on-pump coronary artery bypass grafting,(CABG)与不停跳冠状动脉搭桥手术(off-pump coronary artery bypass grafting,OPCAB)对高危手术病人术后死亡率、并发症发生率等的影响. 方法:从2002年1月至2003年11月,新加坡国立心脏中心共为180例高危冠状动脉粥样硬化性心脏病病人(欧洲心脏手术危险性评估系统Euroscore≥6分)行冠状动脉搭桥术,包括121例CABG(占67.2%)和59例OPCAB(占32.8%).将两组病人术前、术中情况以及术后住院期间的死亡率、并发症发生率等分别进行比较. 结果:术后在血制品的应用、呼吸机辅助时间、呼吸功能不全的发生率、ICU滞留天数以及住院天数等方面,OPCAB均明显优于CABG. 结论:OPCAB对高危冠心病病例具有良好的可行性,与CABG相比,具有明显的优越性.