Quantification of proteinuria in children using the urinary protein-osmolality ratio

A prospective study was conducted to determine the correlation of early morning urinary protein/osmolality ratio (mg/l/mosmol/kg) with 24-h urinary protein excretion (mg/m²/day). Study patients consisted of 53 children (aged 1 month to 15 years). Early morning urine samples and 24-h urine samples were collected and analyzed. In group 1 (children without proteinuria), early morning urinary protein/creatinine ratio (Uprot/Ucr, mg/mg) was 0.061±0.011 and the protein/osmolality ratio (Uprot/Uosm, mg/l/mosmol/kg) was 0.073±0.014. Twenty-four hour urinary protein excretion in group 1 had no significant correlation with Uprot/Ucr or Uprot/Uosm. In group II (children with proteinuria), Uprot/Ucr was 5.78±1.10 and Uprot/Uosm was 4.42±1.34. Twenty- four hour urinary protein excretion in group 2 was 1483.6±303.7 mg/m²/day and its correlation with both Uprot/Uosm and Uprot/Ucr was highly significant (r= 0.87, P<0.001 and r=0.88, P<0.001, respectively). The accepted nephrotic level of proteinuria of 40 mg/m²/h coincides with a Uprot/Uosm ratio of 1.9. In conclusion, early morning urinary Uprot/Uosm is a simple and potentially useful test for 24-h urinary protein excretion, and possibly could be used safely for the assessment of the degree of proteinuria in children. Received: 13 April 1999 / Revised: 23 February 2000 / Accepted: 15 August 2000     

自配试剂免疫透射比浊比率法测定血清CIC

目的:寻求一种全自动仪测循环免疫复合物(CIC)的新方法,以取代传统方法繁琐的手工劳动和略显粗糙的定量结果。方法:自配PEG和BBS试剂,以康宁560全自动生化仪结合AU560全自动生化仪设置程序最佳参数,免疫透射比浊终点法多点定标IPEG和BBS,比率法计算CIC值,以百分回收试验和重复性试验确定其准确度和精密度,以对照试验与传统PEG沉淀法作对比分析。结果:仪测CIC最佳参数设置为:血清:试剂=1:8.λ_1340nm,λ_2450 nm,内源性读数时间20 Sec,总体反应时间288 See,总反应体积为180μl,37℃。本方法与传统PEG沉淀法的回收率、日内和日间变异系数(CV%)分别为97%～110%、3.5%、4.3%和90%～122%、6.8%、9.7%。与传统PEG沉淀法相比,准确性差异无显著性(P>0.05),两者具有较好的相关性(r=0.852),精密度则比手工方法高。结论:自配试剂上机检测CIC,其操作简便易行,且定量相对准确,重现性好,线性范围宽,完全可以取代繁琐的传统操作。     

似然比和受试者工作特征曲线在评价铁参数对铁缺乏症诊断中的应用

目的评价几种铁参数在铁缺乏症诊断中的价值。方法连续性收集９０例贫血病人（缺铁性贫血３６例,慢性病贫血２３例,慢性病伴缺铁性贫血３１例）,做骨髓铁染色、血清转铁蛋白受体（ｓＴｆＲ）、血清铁蛋白（Ｓｅｒｕｍｆｅｒｉｔｉｎ,ＳＦ）、血清铁（Ｓｅｒｕｍｉｒｏｎ,ＳＩ）、总铁结合力（Ｔｏｔａｌｉｒｏｎｂｉｎｄｉｎｇｃａｐａｃｉｔｙ,ＴＩＢＣ）、转铁蛋白饱和度（Ｔｒａｎｓｆｅｒｉｎｓａｔｕｒａｔｉｏｎ,ＴＳ）等检查,应用似然比（ＬＲ）和受试者工作特征（ＲＯＣ）曲线分析方法,以骨髓铁染色作为金标准对以上的铁参数诊断慢性病合并缺铁性贫血的价值进行分析。结果在判断慢性病是否合并缺铁性贫血时ＳＦ在２５～４４μｇ／Ｌ时的ＬＲ最大（５８）,ｓＴｆＲ＞５０ｎｍｏｌ／Ｌ时的ＬＲ最大（６０）;ＲＯＣ曲线下面积以ｓＴｆＲ最大（０８４）,其他依次是ｓＴｆＲ／ｌｏｇＳＦ（０．８３）、ＳＦ（０７７）、ｓＴｆＲ／ＳＦ（０．７４）、ＳＩ（０７２）、ＴＩＢＣ（０６８）。结论认为ＲＯＣ曲线与ＬＲ对科学评价铁参数诊断价值有重要的意义,研究结果对于临床诊断具有重要的参考价值     

The emerging issue of ratio of metastatic to resected lymph nodes in gastrointestinal cancers: An overview of literature

The prognosis of gastrointestinal epithelial malignancies is derived from TNM staging. The nodal status has the most importance. It guides the subsequent adjuvant therapies and gives the oncologist outstanding information about the biology of disease. Recently, a growing number of publications seem to be attributing importance to a ratio of positive to resected lymph nodes as a bad prognostic factor; particularly in gastro-oesophageal carcinomas, colorectal carcinomas and also pancreatic cancer. This particular value predicts the best significance in optimally (nodal) staged carcinomas, with less accurate, but probably equally meaningful information in not adequately resected tumours. Lymph node ratio maintains its value even after neo-adjuvant therapy, a factor known to be able to reduce lymph nodes’ retrieval. The lymph node ratio is most accurate when more specialised pathologists in adequate volume cancer centres perform treatment and harvest of the lymph nodes. To date, no unconventional radiological tool is better able to perform standard armamentarium in correctly defining (preoperatively) patient carriers of massive nodal extension. The accurate definition of nodal staging is crucial for the potential down-staging benefit of neo-adjuvant chemo(radio)therapy on lymph node ratio. In conclusion, lymph node ratio stands out as an independent prognostic factor in adequately (nodal)-staged gastrointestinal epithelial malignancies and could be useful as a stratification factor in future randomised controlled trials.     

International Normalized Ratio (INR), coagulation factor activities and calibrated automated thrombin generation – influence of 24 h storage at ambient temperature

International Normalized Ratio (INR) measurements are used to monitor oral anticoagulation therapy with coumarins. Single coagulation factor activities and calibrated automated thrombin (CAT) generation are considered as more advanced methods for evaluating overall haemostatic capacity. The aims were to assess the variability of INR, coagulation factor activities, and CAT, during 24 h of storage of blood samples at ambient temperature. A total of 24 patients on stable coumarin treatment were followed prospectively for 6 weeks. INR was analyzed at 0, 6 and 24 h after blood sampling and 1-stage clotting activity of coagulation factors II, VII, IX, and X as well as CAT generation was recorded after 0 and 24 h respectively. Statistical analyses included Bland–Altman plot, 95% limits of agreement, and a variability test using a mixed effect model. The level of INR remained statistically unchanged from 0 to 6 and 24 h of storage. Coagulation factor activities and CAT revealed no significant difference induced by 24 h of storage, although the limits of agreement were wide. Patients’ individual INR, coagulation factor activities, and CAT generation were not significantly influenced by 24 h storage of blood samples, but for the CAT generation analyses a trend toward time dependency was detected.     

三尖瓣关闭不全对上腔静脉血流速度频谱的影响

目的探讨不同程度三尖瓣关闭不全对上腔静脉血流速度频谱的影响。方法随机选取三尖瓣关闭不全病例60例及健康对照20例，在胸骨旁四腔或心尖四腔切面测量三尖瓣返流面积与右心房面积之比确定返流程度。经右侧锁骨上窝探查上腔静脉血流速度频谱，记录3个呼吸周期的频谱曲线，观察其形态，计算各参数的呼吸变化率。结果三尖瓣轻度及中度关闭不全时，上腔静脉血流频谱参数的呼吸变化率与对照组无显著差异（P〉0．05），且上腔静脉频谱形态无明显变化（P〉0．05）；三尖瓣重度关闭不全时，上腔静脉频谱参数S、D波的呼吸变化率较对照组明显减低，而VR、AR波增高（P〈0．05），部分患者频谱形态发生变化。结论上腔静脉频谱参数的呼吸变化率随三尖瓣返流程度加重而改变，重度三尖瓣返流会引起上腔静脉频谱形态变化。     

Risk factors for blood transfusion in Cesarean section: A systematic review and meta-analysis

ObjectiveThe current study has been conducted to identify the risk factors associated with blood transfusion in women undergoing cesarean section (C-section). A detailed account of the risk factors associated withblood transfusion will ultimately prevent unnecessary crossmatching in hospitals , leading to the conservation of declining blood supplies and resources without subjugating the quality of care.Material and methodsWe performed a rigorous literature search using electronic databases, including PubMed, Cochrane CENTRAL, and Embase, for studies evaluating the risk factors for blood transfusion in C-section published until March 31, 2021. The Newcastle-Ottawa Quality Assessment Scale was deployed to assess the methodologic quality of the included studies. Mean differences (MD) and odds ratios (OR) with 95% confidence intervals were calculated using Review Manager version 5.3.ResultsThe search yielded 1563 records, 22 of which were eligible for inclusion, representing 426,094 women (10,959 in the transfused group and 415,135 in the non-transfused group). Participants in the transfused group had lower mean preoperative hematocrit (MD = ?3.71 [?4.46, ?2.96]; p < 0.00001; I² = 88%). Placenta previa (OR = 9.54 [7.23, 12.59]; p < 0.00001; I² = 88%), placental abruption (OR = 6.77 [5.25, 8.73]; p < 0.00001; I² = 72%), emergency C-section (OR = 1.92 [1.42, 2.60]; p < 0.0001; I² = 75%), general anesthesia (OR = 8.43 [7.90, 9.00]; p < 0.00001; I² = 72%), multiple gestations (OR = 1.60 [1.24, 2.06]; p = 0.0003; I² = 85%), preterm labor (OR = 3.34 [2.75, 4.06]; p < 0.00001; I² = 85%), prolonged labor (OR = 1.68 [1.44, 1.96]; p < 0.00001; I² = 78%), unbooked cases (OR = 2.42 [1.22, 4.80]; p = 0.01; I² = 80%), hypertensive disorders of pregnancy (OR = 1.81 [1.72, 1.90]; p < 0.00001; I² = 71%), and fibroids (OR = 2.32 [1.55, 3.47]; p < 0.0001; I² = 72%) were significantly higher in the transfused group compared to the non-transfused group. Chronic hypertension (OR = 0.67 [0.29, 1.55]; p = 0.36; I² = 90%), maternal age (MD = 0.09 [?0.27, 0.45]; p = 0.62; I² = 50%), maternal body mass index (MD = ?0.14 [?0.81, 0.53]; p = 0.67, I² = 86%), diabetes (OR = 0.93 [0.75, 1.15]; p = 0.51; I² = 52%), and malpresentation (OR = 0.65 [0.38, 1.11]; p = 0.13; I² = 64%) were not significantly associated with an increased risk of blood transfusion in C-section in the two groups.ConclusionPlacenta previa, placental abruption, emergency C-section, booking status, multiple gestations, and preoperative hematocrit were the risk factors most significantly associated with blood transfusion, while a prior C-section did not increase the risk of transfusion.     

2种静脉穿刺方法在上肢浅静脉穿刺中的比较

目的探讨最佳静脉穿刺方法，提高静脉穿刺成功率，提高病人满意度。方法将住院病人进行分组，单日为实验组，双日为对照组，共穿刺240例次。均选用上肢浅静脉，2组选用相同血管，由专人操作，环境温度相同，药物相同。双日组采用传统的穿刺方法，单日组采用压痕穿刺法，针头斜面向左的方法进行穿刺。将结果进行比较。结果单日组病人疼痛反应轻，对组织盖管损伤小，液体渗强均少于双日组（P〈0．01）。一次穿刺成功率，护理满意度均高于双日组，经统计学处理，差异具有显著意义（P〈0．01）。结论压痕直刺，针头斜面向左在上肢浅静脉穿刺中是最佳方法，安全简便，成功率高。     

Sociodemographic,clinical and birth hospitalization characteristics and infant Hepatitis B vaccination in Washington State

ObjectiveHepatitis B (HepB) vaccine is recommended at birth; however, national coverage estimates fall far below target levels. Studies describing the factors associated with infant HepB vaccination are lacking. This study aimed to identify the sociodemographic, clinical and birth hospitalization factors associated with timely receipt of the first HepB vaccine dose.Study DesignThis retrospective cohort study included Washington State infants born weighing ≥2000 g who received birth hospitalization care at an urban academic medical center between January 2008–December 2013. Multivariable logistic regression was used to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI) for associations between maternal and infant characteristics and HepB vaccine receipt during the birth hospitalization.ResultsOf the 9080 study infants, 75.5% received HepB vaccine during the birth hospitalization. Infants had higher odds of being vaccinated during the birth hospitalization if they were Hispanic (AOR 2.08; CI: 1.63, 2.65), non-Hispanic black (AOR 2.34; CI: 1.93, 2.84) or Asian (AOR 2.70; CI: 2.22, 3.28) compared to non-Hispanic white. Infants with a Spanish- vs. English-speaking mother (AOR 1.97; CI: 1.46, 2.68), public vs. private insurance (AOR 2.01; CI: 1.78, 2.29), and those hospitalized ≥96 h vs. 24 to <48 h (AOR 1.67; CI: 1.34, 2.09) also had higher odds of vaccination.ConclusionsPopulations that are typically underserved (e.g., publicly insured, racial/ethnic minorities) had higher odds of receiving HepB vaccine during the birth hospitalization. These findings may aid in identifying high-risk infants who could benefit from targeted interventions to increase initial HepB vaccination.