Symptoms and occurrences of narcolepsy: a retrospective study of 162 patients during a 10-year period in Eastern China

ObjectiveOur study was designed to assess symptomatology and occurrences of narcolepsy in Eastern China between 2003 and 2012. Herein we report the substantial changes in the occurrence and clinical features of narcolepsy over the last decade in China.MethodsWe performed a retrospective analysis of 162 Han Chinese patients with narcolepsy at Changzheng Hospital, Shanghai, China. Clinical histories and precipitating factors were recorded, in addition to narcolepsy and H1N1 winter flu pandemic (pH1N1) occurrences at Changzheng Hospital. The occurrences also were compared between the Changzheng Hospital and the People’s Hospital, Beijing, China.ResultsIn our sample, narcolepsy occurred 1.73 times more frequently in men than in women. Most of the participants were children, which peaked to 91% in 2010. Excessive daytime sleepiness (EDS), disrupted nocturnal sleep, cataplexy, and weight gain were the four major symptoms. We found that 40% of patients had identifiable precipitating factors. The occurrence of narcolepsy in 2010 showed an approximate three-fold difference from the baseline levels at the Changzheng Hospital, which showed positive relationships with occurrences of pH1N1 in Shanghai and the occurrence of narcolepsy at the People’s Hospital.ConclusionsOur findings show the interactive effects of geography and H1N1 disease in relation to narcolepsy in Han Chinese populations, and strengthen the theoretic hypothesis that immune and mental factors facilitate the onset of narcolepsy.     

在线血容量监测在血液透析患者数据信息系统的应用

目的：依据血容量监测的相关原理及监测方法,将血液透析患者在线血容量监测数据进行信息化管理。方法：将在线血容量监测仪所记载的血液透析患者的治疗参数通过相关技术形式对监测数据进行下载研究分析。结果：血容量监测可以直观了解患者透析过程中血容量的变化,有助于避免透析中低血压的发生,并可评价患者干体重。在充分获取数据的同时,有效利用血容量监测系统（BVMS）,对相关治疗数据进行下载、输出及编辑,实现了信息化管理。结论：通过掌握血容量变化（ΔBV）与血压关联性的画面构成,在一定程度上可以推测血压下降的原因;通过将监测数据相结合可有助于干体重的管理,有利血液透析患者数据信息的管理,并可根据患者临床表现结合血容量监测来确定合适的超滤量,调整干体重,制定适合的治疗方案。     

预防性和治疗性二极管蓝光照射防治极低出生体质量儿高胆红素血症的疗效比较

目的比较预防性和治疗性二极管（LED）蓝光照射防治极低出生体质量儿（VLBWI）高胆红素血症的临床疗效。方法选择2012年11月至2014年2月扬州大学临床医学院产科转入新生儿重症监护中心（NICU）住院的80例VLBWI为研究对象,并采用随机数字表法将其分为采用预防性LED蓝光照射的预防组和采用治疗性LED蓝光照射的治疗组,每组各为40例。观察两组患儿总照射时间、胆红素峰值、黄疸消褪时间、高胆红素血症（血清胆红素水平〉171.0μmol/L）发生率及治疗不良反应（发热、腹泻、皮疹、低钙血症、贫血、青铜症）发生情况。本研究遵循的程序符合扬州大学临床医学院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与之签署临床研究知情同意书。两组患儿入院胎龄、体质量、入院时间、性别、分娩方式比较,差异均无统计学意义（P〉0.05）。结果预防组患儿总照射时间长于治疗组,但两组比较,差异无统计学意义（P〉0.05）,其胆红素峰值、黄疸消褪时间明显低于治疗组,二者比较,差异有统计学意义（P〈0.05）。预防组患儿高胆红素血症发生率显著低于治疗组,两组比较,差异有统计学意义（P〈0.05）。两组患儿治疗不良反应（发热、腹泻、皮疹、低钙血症、贫血、青铜症）发生率比较,差异无统计学意义（P〉0.05）。结论预防性LED蓝光照射防治VLBWI高胆红素血症虽然总照射时间略长于治疗性LED蓝光照射,但其临床疗效显著优于后者,具有便捷、高效、安全、治疗不良反应小等优点。     

Second trimester postload glucose level as an important predictor of low birth weight infants: Tanaka Women's Clinic Study

Although it is well known that the maternal prepregnancy BMI is a strong contributor to fetal growth, our results showed that a low postload glucose level, although within normal range, independent of maternal BMI was strongly associated with an increased risk of low birth weight births among Japanese mothers.     

Preparation,characterization, and antibacterial activity of diclofenac-loaded chitosan nanoparticles

Emerging antibiotic resistance necessitates the development of new therapeutic approaches. Many studies have reported the antimicrobial activity of diclofenac sodium (DIC) and chitosan nanoparticles (CNPs). Hence, this study aimed to prepare non-antibiotic DIC-loaded CNPs (DIC.CNPs) and characterize their in vitro antibacterial activity. DIC.CNPs were prepared from low and high molecular weight (LMW and HMW, respectively) chitosan using an ionic gelation method. Prepared NPs were characterized, and their antibacterial activity against gram-positive Staphylococcus aureus and Bacillus subtilis was evaluated using the agar diffusion and broth dilution methods. The particle size, polydispersity index (PDI), and encapsulation efficiency of the formulated DIC.CNPs increased with increasing MW of chitosan. The prepared NPs showed a narrow size distribution with low PDI values (0.18 and 0.24) and encapsulation efficiency (29.3% and 31.1%) for LMW.DIC.CNPs and HMW.DIC.CNPs, respectively. The in vitro release profile of DIC from the DIC.CNPs was biphasic with a burst release followed by slow release and was influenced by the MW of chitosan. DIC.CNPs exhibited significantly higher antibacterial activity against S. aureus (minimum inhibitory concentration [MIC₉₀] _LMW.DIC.CNPs?=?35?µg/mL and MIC_{90 HMW.DIC.CNPs}?=?18?µg/mL) and B. subtilis (MIC_{90 LMW.DIC.CNPs}?=?17.5?µg/mL and MIC_{90 HMW.DIC.CNPs}?=?9?µg/mL) than DIC alone did (MIC_{90 DIC}?=?250 and 50?µg/mL against S. aureus and B. subtilis, respectively). The antibacterial activity was influenced by pH and the MW of chitosan. Collectively, these results may suggest the potential usefulness of DIC.CNPs as non-antibiotic antibacterial agent necessitating further future studies to asses the stability of DIC.CNPs prepared.     

Poder diagnóstico y pronóstico de los biomarcadores para mejorar el manejo de la neumonía adquirida en la comunidad en los servicios de urgencias

Objectives

To analyse the usefulness and performance of several biomarkers [C-reactive protein (CRP), mid-regional pro-adrenomedullin (MR-proADM), procalcitonin (PCT)] and lactate in predicting short- and medium-term mortality compared with the prognostic severity scales (PSS) usually employed for community-acquired pneumonia (CAP) and in assessing the aetiological suspicion of infection by Streptococcus pneumoniae and bacteraemia.

Methods

Observational, prospective and analytical study was conducted on patients who were diagnosed with CAP in our emergency department (ED). The data collected included socio-demographic and comorbidity variables, Charlson index, priority level according to the Spanish Triage System (STS), stage in the Pneumonia Severity Index (PSI) and in the CURB-65 (confusion, urea, respiratory rate, blood pressure and age ≥ 65 years), criteria of severe CAP, microbiological studies, and biomarkers determinations. The patients were followed-up for 180 days to calculate the prognostic power and the diagnostic performance for bacteraemia and aetiology.

Results

A total of 127 patients were finally enrolled in the study. The 30-day mortality was 10.3% (13), and 22.6% (28) at 180 days. Blood cultures were positive in 29 patients (23%) and S. pneumoniae was identified as the responsible pathogen in 28 cases (22.2%). The area under the ROC curve (AUC-ROC) for lactate and MR-proADM to predict 30-day mortality was 0.898 (95% CI: 0.824-0.973; P < .0001) and 0.892 (95% CI: 0.811-0.974; P < .0001), respectively, and for MR-proADM at 180 days it was 0.921 (95% CI: 0.874-0.968; P < .0001). The AUC-ROC for PCT to predict bacteraemia was 0.952 (95% CI: 0.898-1.000; P < .0001) and, considering a cut-off value ≥ 0.95 ng/ml, the negative predictive value (NPV) and the likelihood ratio (LR+) were 97.8% and 9.03, respectively. Using a PCT cut-off value > 0.85 ng/ml, the NPV and the LR+ were 96.6% and 5.89%, respectively, to predict a S. pneumoniae infection.

Conclusions

MR-proADM and lactate showed a similar or even better performance for 30-day intra-hospital mortality than PSI, CURB-65, STS and CAP severity criteria in patients diagnosed with CAP (P > .05). Furthermore, the MR-proADM capacity to predict 180-day mortality was higher than PSS and the rest of biomarkers (P > .05), and its AUC-ROC increased if it was used in combination with PSI, CURB65 and STS. The determination of PCT has a remarkable diagnostic performance to rule out bacteraemia and to orientate the aetiology towards a S. pneumoniae infection.