Effects of decabrominated diphenyl ether (PBDE 209) on voltage‐gated sodium channels in primary cultured rat hippocampal neurons

Polybrominated diphenyl ethers (PBDEs) are widely used as flame‐retardant additives. But the application of PBDEs has been challenged due to their toxicity, especially neurotoxicity. In this study, we investigated the effects of decabrominated diphenyl ether (PBDE 209), the major PBDEs product, on voltage‐gated sodium channels (VGSCs) in primary cultured rat hippocampal neurons. Employing the whole‐cell patch‐clamp technique, we found that PBDE 209 could irreversibly decrease voltage‐gated sodium channel currents (I_Na) in a very low dose and in a concentration‐dependent manner. We had systematically explored the effects of PBDE 209 on I_Na and found that PBDE 209 could shift the activation and inactivation of I_Na toward hyperpolarizing direction, slow down the recovery from inactivation of I_Na, and decrease the fraction of activated sodium channels. These results suggested that PBDE 209 could affect VGSCs, which may lead to changes in electrical activities and contribute to neurotoxicological damages. We also showed that ascorbic acid, as an antioxidant, was able to mitigate the inhibitory effects of PBDE 209 on VGSCs, which suggested that PBDE 209 might inhibit I_Na through peroxidation. Our findings provide new insights into the mechanism for the neurological symptoms caused by PBDE 209. © 2009 Wiley Periodicals, Inc. Environ Toxicol 25: 400–408, 2010.     

持续性膨肺在机械通气患者开放式吸痰后应用的效果分析

目的评价机械通气患者在开放性吸痰后实施持续性膨肺后对生命体征的影响的效果分析。方法选择建立人工气道行机械通气的9例患者,在实施开放性吸痰后采用延长吸气时间进行持续性膨肺治疗,观察患者吸痰前后对血压、心率、末梢血氧饱和度等参数的影响,记录持续性膨肺患者治疗后的血气分析的变化。结果通过开放式吸痰后膨肺处理的9例患者,其生命体征逐渐趋于平稳。结论对机械通气治疗的患者在开放式吸痰后选择性的给予持续性膨肺,能够使萎陷的肺泡得到复张,降低肺不张的发生率,而且不会造成生命体征的改变。     

Estimation of chlorpyrifos distribution in forensic visceral samples and body fluids using LCMS method

The ingestion of the insecticide chlorpyrifos leads to fatal intoxication in suicidal cases, and its distribution can be assessed only after post-mortem. This study attempted to investigate the distribution of chlorpyrifos in forensic visceral tissue samples like stomach, liver, kidney, heart, brain, lung, spleen, muscle and body fluids like blood and urine by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) with the liquid-liquid extraction method. An analysis time of 8.77 min with 1 μl as an injection volume was chosen. The results obtained are analysed using Labsolutions insight LCMS software, considering Multiple Reaction Monitoring (MRM) and Retention Time (RT). Our findings depict that the stomach tissue has very high concentrations of chlorpyrifos, which suggests the possibility of high distribution and aspiration in the stomach tissue. The concentration of chlorpyrifos in stomach tissue ranged from 816 to 901 μg/g in male cadavers and from 443 to 612 μg/g in female cadavers. Among all the tissues, the stomach tissue showed the highest concentration, while the lowest concentration was found in muscle. Metabolic distribution of chlorpyrifos from the stomach contents to the other surrounding organs may occur and hence the concentrations of CPF were also seen in other organs like the liver, lung, kidney, brain, and muscle. These toxicological results from autopsy findings, together with LC-MS/MS indicate that stomach tissue examination gives an accurate profile of insecticide poisoning in forensic samples with acute poisoning.     

The association between vital signs and major hemorrhagic injury is significantly improved after controlling for sources of measurement variability

Purpose

Measurement error and transient variability affect vital signs. These issues are inconsistently considered in published reports and clinical practice. We investigated the association between major hemorrhagic injury and vital signs, successively applying analytic techniques that excluded unreliable measurements, reduced transient variation, and then controlled for ambiguity in individual vital signs through multivariate analysis.

Methods

Vital sign data from 671 adult prehospital trauma patients were analyzed retrospectively. Computer algorithms were used to identify and exclude unreliable data and to apply time averaging. An ensemble classifier was developed and tested by cross-validation. Primary outcome was hemorrhagic injury plus red cell transfusion. Areas under receiver operating characteristic curves (ROC AUCs) were compared by the test of DeLong et al.

Results

Of initial vital signs, systolic blood pressure (BP) had the highest ROC AUC of 0.71 (95% confidence interval, 0.64-0.78). The ROC AUCs improved after excluding unreliable data, significantly for heart rate and respiratory rate but not significantly for BP. Time averaging to reduce temporal variability further increased AUCs, significantly for BP and not significantly for heart rate and respiratory rate. The ensemble classifier yielded a final ROC AUC of 0.84 (95% confidence interval, 0.80-0.89) in cross-validation.

Conclusions

Techniques to reduce variability in vital sign data can lead to significantly improved diagnostic performance. Failure to consider such variability could significantly reduce clinical effectiveness or confound research investigations.     

无线生命体征动态监测系统在ICU危重患者中的应用

目的采用目前最先进的射频识别（RFID）技术,实现体温动态监测,并实时监测患者当前的活动区域。方法90名危重患者实行随身佩戴内置温度感应器的标签,实现患者体温数值的动态采集,采用同期自身对照方法将通过RFID标签监测得到的体温精确度与腋温测量值相比较,并调查两种测温方法模拟每日所需护理耗时。结果不同时间测得体温值,传感器组分别为15min（36．58±0．92）℃,30min（36．69±0．97）℃,60min（37．08±0．85）℃,90min（37．34±1．03）℃,120min（37．45±1．03）oC,150min（36．88±0．97）℃,与水银体温计组相似15min（36．53±0．94）℃,30min（36．75±0．89）oC,60min（37．04±0．92）℃,90min（37．39±0．99）oC,120min（37．41±0．99）℃,150min（36．85±0．89）℃,两组比较差异均无统计学意义（t分别为0．34,-0．86,0．76,-0．54,0．35,0．63;P均〉0．05）;每日所需护理时间,传感器组（23．78±5．57）min,水银体温计组（201．25±16．37）min,两组比较差异有统计学意义（t=-9．75,P〈0．01）。结论采用RFID技术体温动态监测系统,可将实时监测的数据显示在生命体征动态监测系统的监测界面,同时实时向医院信息系统传输体温信息,护士无需在影响患者休息的情况下就可以立即监测到患者当前体温情况,大大减少了护理人员工作量,并能使医生、护士及与患者相关科室之间实现患者信息资源共享。     

肺移植受者等待供肺期间认知行为干预模式及效果评价

目的 探讨适合肺移植受者等待供肺期间的认知行为干预模式,评价其改善患者身心状态的效果.方法 将50例进行术前评估的肺移植受者随机分为实验组和对照组各25例,对照组接受常规治疗和护理,实验组除接受常规治疗和护理外还接受认知行为干预.在2组患者入院时、入院2周和4周时分别采用Zung焦虑自评量表(SAS)进行评定,并测量2组生命体征的变化.结果 入院2周和4周时实验组SAS得分低于对照组,随干预时间的延长,SAS得分逐渐降低;入院4周时实验组收缩压低于对照组,但2组舒张压组间和组内比较差异无统计学意义;入院2周和4周时实验组心率值低于对照组,实验组入院4周时心率值较入院时下降;入院4周时实验组呼吸频率低于同期对照组和自身刚入院时水平.结论 认知行为干预可降低肺移植受者等待供肺期间的焦虑程度,保持生命体征平稳,具有较好的可行性和有效性.     

Buzzing away the pain: Using an electric toothbrush for vibration anesthesia during painful procedures

Many dermatologic procedures are painful and traumatic, for both pediatric patients and providers alike. Vibration anesthesia has recently been discussed as an effective method for reducing pain associated with injections, but some vibration machines can be cost prohibitive for providers. We describe how to employ an electric toothbrush as an inexpensive and effective option to provide vibration anesthesia during painful pediatric procedures.     

Pro-equity immunization and health systems strengthening strategies in select Gavi-supported countries

BackgroundAchieving universal immunization coverage and reaching every child with life-saving vaccines will require the implementation of pro-equity immunization strategies, especially in poorer countries. Gavi-supported countries continue to implement and report strategies that aim to address implementation challenges and improve equity. This paper summarizes the first mapping of these strategies from country reports.MethodsThirteen Gavi-supported countries were purposively selected with emphasis on Gavi’s priority countries. Following a scoping of different documents submitted to Gavi by countries, 47 Gavi Joint Appraisals (JAs) for the period 2016–2019 from the 13 selected countries were included in the mapping. We used a consolidated framework synthesized from 16 different equity and health systems frameworks, which incorporated UNICEF’s coverage and equity assessment approach – an adaptation of the Tanahashi model. Using search terms, the mapping was conducted using a combination of manual search and the MAXQDA qualitative analysis tool. Pro-equity strategies meeting the inclusion criteria were identified and compiled in an Excel database, and then populated on a tableau visualization dashboard.ResultsIn total, 258 pro-equity strategies were implemented by the 13 sampled Gavi-supported countries between 2016 and 2019. The framework determinants of social norms, utilization, and management and coordination accounted for more than three-quarters of all pro-equity strategies implemented in these countries. The median number of strategies reported per country was 17. Afghanistan, Nigeria, and Uganda reported the highest number of strategies that we considered as pro-equity.ConclusionFindings from this mapping can be useful in addressing equity gaps, reaching partially immunized, and ‘zero-dose’ vaccinated children, and valuable resource for countries planning to implement pro-equity strategies, especially as immunization stakeholders reimagine immunization delivery in light of COVID-19, and as Gavi finalizes its fifth organizational strategy. Future efforts should seek to identify pro-equity strategies being implemented across additional countries, and to assess the extent to which these strategies have improved immunization coverage and equity.     

Defunciones por COVID-19: no están todas las que son y no son todas las que están

The death counts from COVID-19 have generated public controversy. The regional health councils’ need for information regardind the cases, has generated a variety of formats and procedures, used to report this information. Consecuently, this data has not always been communicated in a comparable maner to the Ministry of Health. The compilation of mortality statistics is complex. Central and autonomous public administrations are involved, and not in the same way. The medical death certificate (DC) is the main source of information that allows to specify place of occurrence and causes of death. The on-line registration of the DC in the computerized civil registry and/or digital medical records, would allow to establish a statistical processing circuit, and to obtain a death count more quickly according to causes of death in the event of a health emergency. This requires a multi-level institutional agreement for a total telematics statistic process of death causes in Spain.