alpha-Amylase determination using maltopentaose as substrate

The rationale of choosing a NADP-coupled continuous method, with the substrate maltopentaose, as a method for the determination of alpha-amylase (EC 3.2.1.1) activity is investigated. The method presented is investigated with respect to all reaction parameters, including possible influence of protein, and shows zero order reaction kinetics after a 5-6 minute lag phase. The blank reaction from maltopentaose substrate is constant and is 13% of the upper limit of the reference interval for serum. The course of the blank reaction can be used to check that the maltopentaose is of adequate purity for use in the assay. Km for maltopentaose is 0.48 mmol/l. There is no interference from endogenous glucose when the total NADP turnover is less than 0.25 mmol/l. Data for sensitivity, linearity and long term precision over an eighteen month period are given, together with reference intervals for serum and for urine. The method is recommended for consideration as a reference method.     

超声对腹部脏器损伤的诊断与临床价值

本文对138例腹部脏器损伤进行超声诊断并与手术诊断进行对照分析。结果显示肝脾实质性脏器损伤符合率为94.7%;肾破裂符合率为100%;胃肠空腔脏器损伤符合率63.1%;宫外孕破裂为90.9%;黄体破裂为85.7%;总符合率为88.4%。本文分析了误、漏诊原因,讨论了超声检查对各类腹部脏器损伤的诊断价值。     

Anti-hyperlipidemic agents

There are several drugs for hyperlipidemia except for statin and fibrate. Resin is a commonly used drug for hypercholesterolemia and is known to very useful for the prevention of coronary heart disease(CHD). Probucol is also used for hypercholesterolemia and recently is known that it prevent the restenosis of the coronary artery after PTCA. Nicotinic acid is used for hypertriglyceridemia and hypercholesterolemia, both. It is also known to very useful for the prevention of CHD. Eicosapentaenoic acid is effective for hypertriglyceridemia and also shows an inhibition of platelets aggregation. These drugs as well as statin and fibrate are used in combination with each other for severe hyperlipidemia.     

Disordered permeability of the glomerular filter for middle- and high-molecular serum proteins in various morphologic types and stages of chronic glomerulonephritis

Investigation of glomerular filter permeability for serum immunoglobulins and albumins in 83 patients with chronic glomerulonephritis (CGN) with nephrotic proteinuria has shown that in mesangioproliferative glomerulonephritis permeability for IgM is rare, for IgA and IgG moderately raised; in a marked but not maximum degree of permeability for albumins, it is characterized by considerable variability. In maximum permeability for albumins there is a tendency to the reduction of the ratio of IgA and IgM clearances to albumin clearance, and variability of these indices. In membranous CGN the structure of nephron permeability for serum proteins is identical but it remains unchanged with a sharp rise of albumin fractional clearance. In mesangiocapillary CGN permeability for IgM is more frequent and enhanced for IgG. in focal-segmental glomerular hyalinosis/sclerosis and diffuse-fibroplastic GN permeability for IgG is considerably raised unrelated to a degree of permeability for albumins. Sclerotic changes are accompanied by elevated permeability for IgG.     

The strategy of new imaging procedures in the diagnosis of malignant bone processes

From the comparison of conventional radiography, computed tomography and angiography the diagnostic value of each of these methods is evaluated. Conventional radiography will remain the most significant method for detecting primary skeletal tumours even if magnetic resonance imaging is considered. CT is an important additional method for the evaluation of tumour size, but is disappointing for tumour classification. Bone scintigraphy is the most sensitive method for the differentiation of solitary and multiple tumours. Angiography is not necessary, except for the planning of surgery in certain cases.     

A fully automated method for sample clean-up prior to chromatographic and immunological analysis

A fully automated technique for the extraction and clean-up of low-molecular weight analytes from human serum and urine is presented. Its efficiency for sample clean-up prior to immunological assay is demonstrated for six adrenal and gonadal steroid hormones, calcidiol and the peptide hormones gastrin, insulin and glucagon. A more intensive sample clean-up, which is mandatory for liquid chromatographic analysis, is reported for serum cortisol. With the exception of calcidiol, the extraction of steroids is almost complete. Recovery of peptides is about 80% and depends on the nature of the peptide and on protein-analyte dissociating diluents. Precision of recovery is lower than 7% (CV) for all analytes studied. One hundred serum or urine samples can be cleaned up without loss of efficiency by only one solid-phase cartridge. The technique is in principle applicable to all other analytes with physico-chemical structures similar to the analytes in the present study.     

Accreditation. Its nature, process, and effective implementation

The purpose of this article is to describe what accreditation is, how it operates, and how it can be used effectively for self-improvement. The nature of accreditation is presented in terms of its definition, purpose, types, and governmental influence. Accreditation is presented as a four-step process, of which self-study is the foremost step. Seven principles for a successful self-study are discussed. When accreditation is viewed and administered appropriately, it is an opportunity for self-improvement and a tool for quality assurance.     

Review article: Hypertonic saline use in the emergency department

Hypertonic saline (HS) is being increasingly used for the management of a variety of conditions, most notably raised intracranial pressure. This article reviews the available evidence on HS solutions as they relate to emergency medicine, and develops a set of recommendations for its use. To conclude, HS is recommended as an alternative to mannitol for treating raised intracranial pressure in traumatic brain injury. HS is also recommended for treating severe and symptomatic hyponatremia, and is worth considering for both recalcitrant tricyclic antidepressant toxicity and for cerebral oedema complicating paediatric diabetic ketoacidosis. HS is not recommended for hypovolaemic resuscitation.     

Cerebral infarction

Diabetes mellitus is the second major risk factor for ischemic stroke. Recent increase in atherothrombotic stroke appears to be related with recent increasing of diabetes. Diabetes is, however, a risk factor not only for atherothrombotic stroke but also for lacunar stroke because there is no difference in prevalence of diabetes between atherothrombotic and lacunar strokes. Diabetes can be a risk factor for cardioembolic stroke as well because the major cause of cardioembolic stroke is atrial fibrillation, and diabetes is a risk factor for stroke in patients with atrial fibrillation. Acute ischemic stroke should be classified into above three subtypes according to the brain and artery imaging as well as cardiac sources of embolism. In hyper-acute patients within 3 hours of onset and without early ischemic signs on CT or ischemic lesions less than one third of the hemisphere on magnetic resonance diffusion-weighted imaging, thrombolytic therapy with alteplase is indicated. In acute stroke patients later than 3 hours of onset, argatroban, heparin, and ozagrel are indicated for atherothrombotic, cardioembolic, and lacunar stroke, respectively. For stroke prevention, total management is required by simultaneous treatments for all risk factors existed. In secondary prevention for stroke, in addition to the more strict control of risk factors antithrombotic therapy is required, that is, antiplatelet therapy is indicated for non-cardioembolic stroke, and anticoagulant therapy is indicated for cardioembolic stroke.     

Properties of simple randomization in clinical trials

This article presents the properties of complete randomization (e.g., coin toss) and of the random allocation rule (random permutation of n/2 of n elements). The latter is principally used in cases where the total sample size n is known exactly a priori. The likelihood of treatment imbalances is readily computed and is shown to be negligible for large trials (n greater than 200), regardless of whether a stratified randomization is used. It is shown that substantial treatment imbalances are extremely unlikely in large trials, and therefore there is likely to be no substantial effect on power. The large-sample permutational distribution of the family of linear rank tests is presented for complete randomization unconditionally and conditionally, and for the random allocation rule. Asymptotically the three are equivalent to the distribution of these tests under a sampling-based population model. Permutation tests are also presented for a stratified analysis within one or more subgroups of patients defined post hoc on the basis of a covariate. This provides a basis for analysis when some patients' responses are assumed to be missing-at-random. Using the Blackwell-Hodges model, it is shown that complete randomization eliminates the potential for selection bias, but that the random allocation rule yields a substantial potential for selection bias in an unmasked trial. Finally, the Efron model for accidental bias is used to assess the potential for bias in the estimate of treatment effect due to covariate imbalance. Asymptotically, this probability approaches zero for complete randomization and for the random allocation rule. However, for finite n, complete randomization minimizes the probability of accidental bias, whereas this probability is slightly higher with a random allocation rule. It is concluded that complete randomization has merit in large clinical trials.     

醋酸氯己定体外抗菌作用的实验观察

目的观察醋酸氯己定体外抗菌作用。方法采用肉汤稀释法,测定了醋酸氯己定对4种条件致病菌和一种厌氧菌的抗菌效果。结果醋酸氯己定对脆弱拟杆菌MIC为4μg/ml,MBC为8μg/ml;对产气荚膜梭菌的MIC为1μg/ml,MBC为2μg/ml。醋酸氯己定对金黄色葡萄球菌MIC为0.0625μg/ml,MBC为0.125μg/ml;对大肠埃希菌MIC为2μg/ml,MBC为4μg/ml;对铜绿假单胞菌MIC为4μg/ml,MBC为4μg/ml;奇异变形杆菌MIC为8μg/ml,MBC为8μg/ml。结论醋酸氯己定对常见条件致病菌和厌氧菌都有良好的体外抗菌作用。     

The epidemiologic approach to the study of clinical nursing diagnoses

There is a nomenclature for classifying personal features of the host, that is, the patient. There is a nomenclature for classifying features of disease such as organs, tissues, and cells. There is also a nomenclature for classifying agents of treatment such as drugs. But there is no nomenclature in in either clinical medicine or clinical nursing for the classification of the features of interaction between the host and the disease, that is, the illness of the patient.     

早产儿皮肤保暖法探讨

目的 为了对早产儿实施有效的保暖，降低硬肿症的发生率及成功的实施母乳喂养。方法对84例无窒息早产儿，按出生体重和孕周分组保暖观察，观察组用母婴皮肤接触保暖法，对照组用恒温箱保暖法。结果 观察组升温快，升温时间1．5－2．2h（升至36．5度），硬肿发生率2．4％，方便母乳喂养，无乳头错觉产生，产妇喂养信心足，而对照组或温慢，升温时间4－6h，不方便母乳喂养，来回抑奶，体温不稳定，硬肿发生率14．3％，容易发生乳头错觉，产妇喂养信心不足，两组保暖方法经统计学处理，升温时间及产妇母乳喂养信心差异均有极显著性意义，P＜0．01，硬肿症发生率差异有显著意义，P＜0．05。结论母婴皮肤接触保暖法优于恒温箱保暖法。     

Conventional and sustained-release procainamide: update on pharmacology and clinical use

Hemodynamic and electrophysiologic effects of procainamide, the pharmacokinetic properties of conventional and sustained-release forms of the drug, guidelines for its administration and dosage, and contraindications for and adverse effects of its use are outlined. A review of clinical studies of procainamide therapy concludes that in the treatment of ventricular arrhythmia it is comparable to other class IA drugs and generally superior to beta-blockers and to class IB drugs. For atrial arrhythmias, procainamide is usually the drug of choice when intravenous therapy is indicated; for oral prophylaxis, quinidine or the sustained-release form of procainamide is more effective than conventional formulation oral procainamide. Because procainamide is the only class I antiarrhythmic drug currently available that is commonly administered intravenously and orally, it is frequently the drug of choice for patients requiring both immediate and intermediate periods of arrhythmia control. It is often the drug of choice for initial testing with programmed electrical stimulation.     

南京地区机关人群高尿酸血症的临床分析

目的调查南京地区机关人群高尿酸血症患病情况。方法对10 981名机关工作人员的体检数据进行分析,统计高尿酸血症检出率,分析高尿酸血症患者性别和年龄分布及与高血糖、高血脂关系。结果高尿酸血症检出率18.38%,其中男性的检出率为21.40%,与年龄无特异性差别,高血脂是导致高尿酸血症的危险因素;女性的检出率为12.71%,并随年龄的增加呈现逐步上升趋势,高血糖、高血脂是导致高尿酸血症的危险因素。结论高血糖、高血脂及年龄增加是导致女性高尿酸血症的危险因素,男性高尿酸血症的发生与高血糖、年龄无关。     

Prevention of Perinatal Group B Streptococcal Disease: Updated CDC Guideline

Group B streptococcus is the leading cause of early-onset neonatal sepsis in the United States. Universal screening is recommended for pregnant women at 35 to 37 weeks' gestation. The Centers for Disease Control and Prevention recently updated its guideline for the prevention of early-onset neonatal group B streptococcal disease. The new guideline contains six important changes. First, there is a recommendation to consider using sensitive nucleic acid amplification tests, rather than just routine cultures, for detection of group B streptococcus in rectal and vaginal specimens. Second, the colony count required to consider a urine specimen positive is at least 104 colony-forming units per mL. Third, the new guideline presents separate algorithms for management of preterm labor and preterm premature rupture of membranes, rather than a single algorithm for both conditions. Fourth, there are minor changes in the recommended dose of penicillin G for intrapartum chemoprophylaxis. Fifth, the guideline provides new recommendations about antibiotic regimens for women with penicillin allergy. Cefazolin is recommended for women with minor allergies. For those at serious risk of anaphylaxis, clindamycin is recommended if the organism is susceptible or if susceptibility is unknown, and vancomycin is recommended if there is clindamycin resistance. Finally, the new algorithm for secondary prevention of early-onset group B streptococcal disease in newborns should be applied to all infants, not only those at high risk of infection. The algorithm clarifies the extent of evaluation and duration of observation required for infants in different risk categories.     

Exploring the use of CircAid legging in the management of lymphoedema

Lymphoedema is a potentially disfiguring chronic condition that can have significant physical, psychological and social consequences for the affected individual. Treatment consists of a combination of exercises and massage to increase lymph drainage, and the use of compression hosiery to maintain improvements. This intensive treatment is delivered by trained therapists over several seeks, and is time-consuming for both patient and therapist. Maintaining improvements following intensive therapy is difficult, and there is often a need for further courses of intensive therapy. In the maintenance phase of treatment the patient is taught to care for the swollen limb with a routine of skin care, exercise, simple lymphatic drainage and compression hosiery. Compression is the mainstay of this phase of management, but a regular supply of high-compression garments is costly. The CircAid legging is a non-elastic adjustable compression appliance worn on the lower leg which can be an effective adjunct to compression garments. Three case studies are presented to show that the use of the CircAid legging in the management of patients following intensive therapy can enhance the effect of standard compression hosiery. Implications for clinical practice are discussed, as is the need for further research.     

What is the best site for central venous catheter insertion in critically ill patients?

The choice of the best central venous access for a particular patient is based on the rate and the severity of failures and complications. Based on two recent papers, internal jugular access is associated with a low rate of severe mechanical complications in the intensive care unit as compared with subclavian access, and it is preferable for short-term access (<5–7 days) and for haemodialysis catheters. Subclavian access is associated with a lower risk for infection and is the route of choice, in experienced hands, if the risk for infection is high (central venous catheter placement >5–7 days) or if the risk for mechanical complications is low. The femoral route is associated with a higher risk for infection and thrombosis (as compared with the subclavian route). It should be restricted to patients in whom pneumothorax or haemorrhage would be unacceptable.     

Exzessives, zwanghaftes Kaufen oder „Verhaltenssucht”? Ein Fallbeispiel

Compulsive buying is characterized by repetitive compulsive and excessive misappropriated buying. Labels for this pathological behavior vary and its classification is uncertain. To date, there is no consistent concept for diagnosis and treatment. We present the case of a 36-year old woman with a history of excessive pathological buying. According to the assumption that addiction is a learned behavior, we assume that for the patient compulsive buying as a rewarding behavior has the function of an inadequate stress coping strategy. Therefore, in this case the diagnosis "non-substance-related behavioral addiction" is appropriate. This diagnosis is important for the choice of the therapeutic intervention, which is in accordance to the current therapeutic interventions for substance-related addictions.     

Using disease progression models as a tool to detect drug effect

Generally, information required for approval of new drugs is dichotomous in that the drug is either efficacious and safe or not. Consequently, the purpose of most confirmatory clinical trials is to test the null hypothesis. The primary reasons for designing hypothesis testing trials are to provide the information required for approval using analyses techniques that are relatively straightforward and free of apparent assumptions. However, the information required for approval is very different from that used by prescribers for decision making. In the clinic, decisions must be made about dose adjustment for individual patients in the presence of additional therapies and co-morbidities. Choice of drug and dosing regimen is therefore a classical risk to benefit decision that is often poorly informed from the results of confirmatory trials. Therefore, providing answers to the more difficult question of how to use the drug in a clinical setting is essential.